Family Practice News articles from November 2006

Family Practice News archives from November 2006

Doctors sue over network exclusion.
November 1, 2006... In a move that challenges methods used to assess physician performance, six Washington state physicians and the Washington State Medical Association have filed suit against Regence BlueShield after the insurer used internal quality data to...

Once-yearly zoledronic acid cuts fracture rates: therapy reduced the risk by 25% to 75%.(Clinical report)
November 1, 2006... PHILADELPHIA -- Once-yearly therapy with zoledronic acid has resulted in impressive reductions in fracture incidence at the three most common fracture sites in postmenopausal women with osteoporosis, according to phase III findings presented at...

Cochrane: pioglitazone's risk:benefit ratio 'unclear'.(treatment of type 2 diabetes)
November 1, 2006... A new systematic review by the Cochrane Collaboration of the diabetes drug pioglitazone concludes that until new evidence becomes available, the drug's risk-benefit ratio--and its place in the treatment of type 2 diabetes--"remains unclear."...

Median income lower for women in family medicine practices.(Statistical table)(Brief article)
November 1, 2006... Median income lower for Women in Family Medicine Practices With OB Without OB Male $181,426 $170,537 Female $151,284 $135,000 Source: 2005 survey data, Medical Group Management Association

Integration of VFA, bone density data more sensitive for fracture risk in men.(vertebral fracture assessment)
November 1, 2006... PHILADELPHIA -- The addition of vertebral fracture assessment to bone mineral density measurement identified almost 20% of men at increased risk for future vertebral and peripheral fractures who might otherwise have been missed by dual-energy...

First Gene-based assay approved for detecting HIV-1 before antibodies.(human immunodeficiency virus)(Brief article)
November 1, 2006... An assay that detects the RNA of HIV-1 has been approved by the Food and Drug Administration, making a gene-based test for the virus available to medical diagnostic laboratories for the first time. Last month, the FDA announced the approval...

Prophylactic PPI cuts bleeding in aspirin users.(proton pump inhibitor)
November 1, 2006... BARCELONA -- Concomitant proton pump inhibitor therapy reduced by 71% the relative risk of gastroduodenal ulcers in patients taking continuous low-dose aspirin for secondary cardiovascular or cerebrovascular prevention, according to the...

Drug approved for autism-associated symptoms.
November 1, 2006... The Food and Drug Administration has approved risperidone for treatment of irritability associated with autism. This approval addresses aggression, deliberate self-injury, and temper tantrums in children aged 5 years and older, and in...

Off-label androgen therapy for women.(treating female sexual dysfunction)
November 1, 2006... Although male sexual dysfunction has grabbed the lion's share of the headlines and punch lines, it is important that women also receive optimal care for this condition. A landmark study in 1999 indicated that about 43% of American women...

Video games and aggression in kids.(Letter to the editor)(Brief article)
November 1, 2006... I read with interest the article concerning aggression in children which discussed the work of Dr. Susan Lomax ("Source of Aggression Determines Therapy," Sept. 1, 2006, p. 39). I have been treating children with aggression in my behavioral...

What's right with medicare.(Letter to the editor)
November 1, 2006... I was pleasantly surprised to see the report on payer performance because I'm tired of reading articles that badmouth Medicare ("Humana, Medicare Rank Well on Payer Measures," Aug. 1, 2006, p. 51). For years, Medicare has been our best...

Should inflammatory markers be the basis of monitoring asthma?
November 1, 2006... Yes Asthma is a chronic inflammatory disease. We know the severity of asthma corresponds to the severity of inflammation and that inflammation is treatable. Treatment algorithms that include measures of inflammation improve outcomes, so...

Drug combo trumps rosuvastatin in cutting LDL.(low density lipoprotein)
November 1, 2006... COPENHAGEN -- A combination of ezetimibe and simvastatin provides additional lipid-modifying benefits, compared with rosuvastatin monotherapy in patients with type 2 diabetes or with metabolic syndrome without diabetes, Dr. Alberico L. Catapano...

Post-MI mortality dip bigger with new sulfonylureas.(myocardial infarction)
November 1, 2006... COPENHAGEN -- Newer-generation sulfonylureas appear to be associated with lower post-myocardial infarction mortality in diabetic patients than are the older-generation agents, Dr. Henriette Thisted reported at the annual meeting of the European...

Further benefit of pioglitazone seen in high-risk type 2 patients.
November 1, 2006... COPENHAGEN -- Pioglitazone (Actos) demonstrates a beneficial effect on a variety of measures of cardiovasctflar disease outcome in high-risk patients with type 2 diabetes, speakers said at the annual meeting of the European Association for the...

Low-dose testosterone boosts heart function in men.
November 1, 2006... BARCELONA -- Modest-dose testosterone therapy brought significant functional and symptomatic improvement in men with moderate chronic heart failure in a yearlong double-blind randomized trial, Dr. Christopher J. Malkin said at the joint...

Interim data suggest sildenafil may benefit some HF patients.(heart failure)
November 1, 2006... SEATTLE -- A 12-week study of sildenafil therapy in patients with heart failure due to left ventricular dysfunction and secondary pulmonary hypertension is continuing after an interim analysis found neither therapeutic futility nor overwhelming...

Resistance to aspirin Tx seen in 20% of heart failure patients.
November 1, 2006... SEATTLE -- Blood tests on 507 patients seen in emergency departments for chest pain found resistance to aspirin in 20% of those with a history of heart failure and in 12% of those without heart failure, Dr. Loft B. Daniels reported in a poster...

ECG's role in athletic screening protocol debated.(electrocardiography)
November 1, 2006... A national athletic screening program appears to have cut the rate of sudden death by 89% among adolescent and young adult athletes in Italy, according to Domenico Corrado, Ph.D., of the University of Padua, and his associates. However,...

DVT preventive care should be handled more urgently.(deep vein thrombosis)
November 1, 2006... ROME -- Many health care providers are inappropriately complacent regarding the long-term sequelae of deep vein thrombosis in the lower extremities, speakers said at the annual meeting of the Cardiovascular and Radiological Interventional...

Facilitated thrombolysis devices speed DVT therapy.(deep vein thrombosis)
November 1, 2006... ROME -- Several relatively new percutaneous pharmacomechanical devices may have a major impact on the treatment of deep vein thrombosis, according to speakers at the annual meeting of the Cardiovascular and Radiological Interventional Society...

Metabolic syndrome, elevated biomarker compound heart risk.(Brief article)
November 1, 2006... BARCELONA -- Elevated lipoprotein-associated phospholipase A2 and metabolic syndrome are additive in their predictive power for future cardiovascular events, Dr. Margaretha Persson said at the joint congress of the European Society of...

Not all thyroid cancer patients need follow-up.(iodine-131 ablation to treat thyroid cancer)
November 1, 2006... SAN DIEGO -- Patients with stage I thyroid cancer who have a negative first follow-up test performed within 1 year after iodine-131 ablation have a low risk of recurrence and do not require further thyroid stimulation tests, results from a...

More thyroid tumors being found in women.(Brief article)
November 1, 2006... CALGARY, ALTA. -- The incidence of well-differentiated thyroid carcinoma in Ontario, Canada, jumped 230% between January 1990 and December 2001, apparently because of an increase in small tumors in female patients, researchers reported during a...

Think androgen excess in women with hirsutism.(hyperandrogenism, leading cause of polycystic ovary syndrome)
November 1, 2006... SAN ANTONIO -- Address the underlying androgen excess when a woman presents for correction of cutaneous effects of hyperandrogenism, Dr. Ellen E. Wilson said at a meeting of Skin Disease Education Foundation. Polycystic ovary syndrome...

Race, gender complicate heart disease, BMD link.(bone mineral density)
November 1, 2006... PHILADELPHIA -- White men and black women are at an increased risk for cardiovascular disease for each standard deviation decrease in volumetric bone mineral density, according to data presented at the annual meeting of the American Society for...

Sequential Tx sustains benefits of teriparatide in osteoporosis.(treatment)
November 1, 2006... TORONTO -- Patients with osteoporosis who took daily raloxifene following a yearlong course of treatment with teriparatide maintained bone mineral density gains, whereas those who had no further therapy rapidly lost bone, Dr. Silvano Adami...

Ibandronate shots better in those with GI intolerance.(gastrointestinal intolerance)
November 1, 2006... TORONTO -- Women with postmenopausal osteoporosis who had previously discontinued oral bisphosphonate therapy because of gastrointestinal intolerance preferred an intravenous, every-3-month regimen of ibandronate over a monthly oral regimen,...

Periodic ibandronate injections improve bone density at 2 years.
November 1, 2006... PHILADELPHIA -- Intermittent intravenous injections of ibandronate continue to improve bone mineral density of the spine and hip at 2 years, according to data presented at the annual meeting of the American Society for Bone and Mineral...

FDA approves sitagliptin for glycemic control.(Food and Drug Administration)
November 1, 2006... Sitagliptin phosphate, an agent in the new class known as dipeptidyl peptidase-4 inhibitors, has been approved by the Food and Drug Administration for use as monotherapy or in combination with metformin or a thiazolidinedione. The DPP-IV...

On-site educators lead to better type 2 outcomes.
November 1, 2006... When a diabetic patient needs to see a diabetes educator, convenient access can boost compliance and help improve health outcomes. That's the experience of Dr. Francis X. Solano Jr. and his primary care colleagues, who refer patients with...

Sleep-disordered breathing tied to hyperglycemia in type 2.(Brief article)
November 1, 2006... COPENHAGEN -- Sleep apnea seems to have an immediate elevating effect on nighttime blood glucose levels in people with concomitant type 2 diabetes, said Dr. Maria Pallayova at the annual meeting of the European Association for the Study of...

Survey finds gaps in public's knowledge of flu.
November 1, 2006... WASHINGTON -- Much of the public harbors misperceptions about influenza and vaccination against it, according to data from a nationwide survey presented at a press briefing sponsored by the National Foundation for Infectious Diseases. The...

Only 18% of toddlers get full flu vaccine.(Survey)(Brief article)
November 1, 2006... The Centers for Disease Control and Prevention has reported that data from a nationwide telephone survey indicate that only 18% of children aged 6 months to 2 years were fully vaccinated for influenza in the 2004-2005 influenza season. To...

Financing could thwart access to HPV vaccine.(human papilloma virus)
November 1, 2006... WASHINGTON -- The challenge of paying for vaccinations will become even greater once the human papilloma virus vaccine becomes available in 2007. At a meeting of the National Vaccine Advisory Committee, representatives from several...

Use of raw milk persisted after Oklahoma rabies incident.
November 1, 2006... SAN ANTONIO -- People who drank raw milk purchased at an Oklahoma dairy where a cow tested positive for rabies last year were screened for susceptibility-and in some cases given postexposure prophylaxis--but this did not deter most from...

FluLaval, Remicade.(drug approvals)
November 1, 2006... FluLaval (influenza virus vaccine, ID Biomedical Corporation/ GlaxoSmithKline) An injectable influenza vaccine approved for active immunization of adults ages 18 and older against influenza disease caused by influenza virus subtypes A and...

Genetic assays on horizon for infectious diseases.
November 1, 2006... MONTEREY, CALIF. -- Clinically useful tests are on the horizon to detect changes in DNA that can alter health outcomes for patients with infectious diseases, Dr. Michael E Murray said. Speaking at the annual meeting of the infectious...

Vaccinations are key in shielding HIV patients.(human immunodeficiency virus)
November 1, 2006... WASHINGTON -- Protect HIV-infected patients from additional illness by vaccinating them against influenza, hepatitis A and B, pneumococcal disease, and tetanus-diphtheria, Dr. David H. Spach advised at the Ryan White CARE Act meeting on HIV...

Concerns about being judged may keep students from HIV testing.(human immunodeficiency virus)(Survey)
November 1, 2006... TORONTO -- College students are reluctant to get tested for HIV because they fear being judged by others, according to a poster presented at the 16th International AIDS Conference. In a survey of 491 students at York University, Toronto, 49...

MRSA raises Tx failure rates of diabetic foot infections.(methicillin resistant Staphylococcus aureus)(treatment)
November 1, 2006... SAN FRANCISCO -- The isolation of methicillin-resistant Staphylococcus aureus, either alone or as part of a polymicrobial infection, was associated with treatment failure in 35% of patients with a diabetic foot infection, Dr. Matthew E. Falagas...

Gender differences seen in foot, ankle melanoma.
November 1, 2006... SAN DIEGO -- Melanoma of the foot and ankle occurred far more commonly in women than it did in men, but men were more likely to have thicker tumors that were associated with a worse prognosis, Dr. Hugh T. Greenway said at the annual meeting of...

Melanocytic imposters may masquerade as melanoma in situ on sun-damaged skin.(Skin Disorders)
November 1, 2006... SAN DEIGO -- An accurate diagnosis of melanoma in situ is often lifesaving, but its histology can be difficult to distinguish from benign histologic findings, Dr. Philip E. LeBoit said at the annual meeting of the California Society of...

Nail squamous cell carcinoma varies in presentation.(Brief article)
November 1, 2006... MANCHESTER, ENGLAND -- Squamous cell carcinoma of the nail unit is often misdiagnosed and its painful course protracted because clinical features can resemble more mundane conditions such as paronychia, Dr. Mohamed Alrawi said at the annual...

Aging exerts its toll from alopecia to xerosis.(SKin Disorders)
November 1, 2006... SAN ANTONIO -- Older women are at increased risk for a number of skin conditions including alopecia, xerosis, and foot ulcers, compared with younger women, according to a presentation at a meeting of Skin Disease Education Foundation. "The...

Isotretinoin restrictions eased for select patients.(Skin Disorders)(Brief article)
November 1, 2006... Women who have no chance of becoming pregnant, as well as men, no longer need to observe a 23-day lockout period before starting a new prescription of isotretinoin for the treatment of acne, according to a statement from the Food and Drug...

Late-onset generalized anxiety disorder common.(Mental Health)
November 1, 2006... PARIS -- Generalized anxiety disorder occurs as a late-onset condition more often than is recognized, according to investigators who presented the first large treatment trial in elderly patients during the annual congress of the European...

Triiodothyronine enhances response to sertraline.(Mental Health)
November 1, 2006... PARIS -- Triiodothyronine supplementation significantly increased the antidepressant effects of sertraline in a randomized placebo-controlled clinical trial presented by Dr. Bernard Lerer in a breaking news session at the annual congress of the...

Antidepressants tied only to suicide attempts.(Mental Health)
November 1, 2006... PARIS -- A cohort study of 15,390 suicide-prone people in Finland found those who used antidepressants were much more likely to attempt suicide, but also much less likely to complete suicide or to die of any cause. The use of...

Team approach aids eating disorder recovery.(Mental Health)
November 1, 2006... BETHESDA, MD. -- A multidisciplinary approach to treating eating disorder patients can help to prevent relapse when the treatment team works closely with family members and other concerned individuals, speakers from Johns Hopkins University...

Various factors alter eating disorder brain function, behavior.(Mental Health)
November 1, 2006... BETHESDA, MD. -- A complex set of predisposing, precipitating, and perpetuating factors appears to play a major role in driving the behavioral and neurochemical changes of patients with anorexia or bulimia, Craig Johnson, Ph.D., said at the...

Mood in pregnancy may impact birth outcomes.(Women's Health)
November 1, 2006... PITTSBURGH -- Pregnant women with anxiety or depression have higher levels of [alpha]-amylase, a measure of adrenergic system activity, and lower morning cortisol levels, preliminary results from a longitudinal study demonstrated. The...

Research consortium launched.(Women's Health)(Brief article)
November 1, 2006... The National Institutes of Health has launched a national consortium focused on transforming how clinical research is conducted in the hopes of providing patients with new treatments more quickly and effectively, Twelve institutions have...

Accumulating data on prenatal exposure to SSRIs.(Drugs, Pregnancy, And Lactation)(Selective Serotonin Reuptake Inhibitors)(Column)
November 1, 2006... Over the last year, several studies on possible neonatal effects of prenatal exposure to SSRIs have been reviewed in this column. These studies have raised concerns about potential risks, including congenital malformations--as may be the case...

N-9 spermicides safe for those at low risk of STIs.(Women's Health)(sexually transmitted infections)
November 1, 2006... LA JOLLA, CALIF. -- Spermicides containing nonoxynol-9 are a safe alternative for women who are at low risk of acquiring sexually transmitted infections, according to a study from the University of Pittsburgh. Use of an N-9 spermicide was...

CDC takes aim at dating violence.(Women's Health)(Centers for Disease Control and Prevention)(www.chooserespect.org)(Brief article)
November 1, 2006... The Centers for Disease Control and Prevention has launched a campaign to reduce dating violence by encouraging adolescents to form healthy relationships. The "Choose Respect" program includes games and interactive learning tools, streaming...

Experts debate when to treat androgen deficiency.(Men's Health)
November 1, 2006... BOSTON -- Testosterone therapy should not be offered to all older men with low testosterone levels, according to experts commissioned by the Endocrine Society to examine the treatment of androgen deficiency in adult men. Guidelines issued...

Low level of testosterone may increase all-cause mortality risk.(Men's Health)
November 1, 2006... Men with low testosterone levels seem to be at increased risk of death from all causes and to have shorter survival times than men with normal testosterone levels, said Dr. Molly M. Shores of the departments of psychiatry and behavioral...

Low testosterone associated with prostatic conditions.(Men's Health)
November 1, 2006... CHICAGO -- Men with prostatic disease often present with symptoms of hypogonadism and are more likely to be hypogonadal, compared with patients who do not have prostatic conditions, Dr. Sherwyn L. Schwartz said in a poster presentation at the...

Daily exercise eases back pain in overweight men.(Men's Health)
November 1, 2006... BUENOS AIRES -- Overweight men with chronic or subacute lower back pain can reduce pain intensity and improve overall quality of life by losing weight and exercising daily, according to the results of a study reported by Dr. Eiichhiro Nakamura...

Electrical therapy may speed slow colonic transit.(Digestive Disorders)
November 1, 2006... BOSTON -- A new noninvasive treatment--transcutaneous electrical stimulation--may relieve symptoms for several months in children with slow transit constipation, Bridget Southwell, Ph.D., said at the Neurogastroenterology and Motility 2006...

Lubiprostone provides long-term efficacy for constipation in the elderly.
November 1, 2006... BOSTON -- Approved earlier this year for the treatment of chronic idiopathic constipation in adults, lubiprostone has been shown to provide long-term relief for elderly patients, according to the findings of an industry-sponsored study. ...

Duration of colitis determines screening.(Brief article)
November 1, 2006... LAKE TAHOE, CALIF. -- The frequency of colonoscopies to screen for cancer in patients with Crohn's disease colitis or ulcerative colitis should be based on how long they've had colitis, Dr. Joshua R. Korzenik said at a meeting on...

Adults with juvenile-onset RA need special care.(rheumatoid arthritis)
November 1, 2006... BOSTON -- Adults with juvenile-onset rheumatoid arthritis have greater accumulated morbidity than do those with adult-onset rheumatoid arthritis, and failing to take that into account can lead to suboptimal outcomes, Dr. Peter A. Nigrovic...

Antibiotics, DMARDs have role in lyme arthritis.(disease modifying antirheumatic drugs)
November 1, 2006... BOSTON -- Antibiotic therapy decreases the duration of persistent joint inflammation in Lyme arthritis, and disease-modifying antirheumatic drugs can reduce its severity in individuals with antibiotic-refractory disease, reported Dr. Alan...

Panel backs conditional approval for artificial cervical disk.
November 1, 2006... GAITHERSBURG, MD. -- A federal advisory panel supported the approval of a stainless steel artificial cervical disk for patients with single-level cervical degenerative disk disease, provided that the manufacturer evaluates long-term efficacy...

Cheerleaders' stunts raise risk of serious injury.
November 1, 2006... MIAMI -- Although the overall risk of injury in cheerleading is low, the activity accounts for more than half of all catastrophic sports injuries in females, Dr. Teri McCambridge said at a meeting on pediatric sports medicine sponsored by the...

Dancers present with unique injuries.
November 1, 2006... MIAMI -- Snapping hip syndrome, labral tears, and tibial and metatarsal fractures are injuries unique to dancers, Dr. Craig C. Young said at the annual meeting of the American Medical Society for Sports Medicine. Most research focuses on...

Ill-fitted helmets leave young athletes at risk for concussion.
November 1, 2006... For high school football players, the best defense against concussions is a good offense--and that means a well-fitted football helmet, according to Dr. Eugene Hong. But many high school athletes don't receive a proper helmet fitting,...

Benefit of tight glucose in ICU not worth risks.(intensive care unit)
November 1, 2006... BARCELONA -- The benefits of tight glucose control with insulin therapy may not be worth the risk of hypoglycemia for critically ill patients, Dr. Jean Charles Preiser said at the annual congress of the European Society of Intensive Care...

Glucose levels tied to death during surgery.(Clinical Rounds)(Brief article)
November 1, 2006... BARCELONA -- High serum glucose levels in patients undergoing surgery were associated with significantly higher rates of death and cardiac death in a case-control study with more than 2,000 patients. A statistical analysis showed that every...

Visual impairment, hearing loss tied.(Brief article)
November 1, 2006... Elderly people who have visual impairment are more likely than others to have concomitant hearing loss. Dr. Ee-Munn Chia of the University of Sydney's department of ophthalmology and associates assessed hearing in 1,911 people aged 5508...

Psoriasis is a risk factor for MI.(myocardial infarction)(Brief article)
November 1, 2006... Psoriasis appears to be an independent risk factor for myocardial infarction, conferring the same magnitude of risk as other major cardiac risk factors, according to Dr. Joel M. Gelfand of the University of Pennsylvania, Philadelphia, and his...

Antipsychotics in AD questioned.(Alzheimer's disease)(Brief article)
November 1, 2006... Findings from a study of olanzapine, quetiapine, and risperidone in patients with Alzheimer's disease call into question the clinical value of these second-generation antipsychotic drugs and suggest that physicians should use them judiciously....

Pipeline loaded with novel alzheimer's agents.(clinical trial reports)
November 1, 2006... Investigational drugs that decrease the body's load of both soluble and fibrillar amyloid [beta] (A[beta]) could change a diagnosis of Alzheimer's disease from a death sentence to that of a chronic but manageable illness. Although all of...

Separate addiction from physical dependence: when increasingly higher doses of opioids are needed, greater activity levels may be responsible.
November 1, 2006... ORLANDO -- Do not confuse addiction with physical dependence when prescribing opioids for your chronic pain patients, Dr. Jennifer P. Schneider advised at the annual clinical meeting of the American Academy of Pain Management. Trust...

Five steps help avoid regulatory hassles when prescribing opioids.(Brief article)
November 1, 2006... ORLANDO -- When opioids are prescribed for chronic pain patients, following the five-step VIGIL system can lessen the threat of being scrutinized by the Drug Enforcement Agency. The acronym stands for verification, identification,...

Pediatric cystic fibrosis pain is understudied, undertreated.
November 1, 2006... ANAHEIM, CALIF. -- Children with cystic fibrosis suffer frequent pain in multiple areas of the body, including the abdomen, chest, head, and extremities, reported Tonya M. Palermo, Ph.D., at a meeting sponsored by the Los Angeles Pediatric...

Consider prevention in some teens with migraines.
November 1, 2006... LOS ANGELES -- In any given year, 6% of adolescents aged 12-19 years experience at least one migraine headache, according to the American Migraine Prevalence and Prevention Study released at the annual meeting of the American Headache Society....

Triptan use for teen migraineurs lacks evidence.(Brief article)
November 1, 2006... Los ANGELES -- Triptans are commonly used for the treatment of adolescent migraines, but have never clearly demonstrated efficacy over placebo in randomized, clinical trials of adolescents with migraines. Speaking at the annual meeting of...

AAP will offer developmental screening tool kit: the new document will recommend developmental screenings at the 9-, 18-, and 30-month visits.(American Academy of Pediatrics)
November 1, 2006... Family physicians will soon have new tools for the early diagnosis of developmental problems in young children. Officials with the American Academy of Pediatrics are finalizing the details of the new edition of the Bright Futures:...

Fluoroquinolones up diabetics' hyperglycemia risk.
November 1, 2006... SAN FRANCISCO -- The risk for hyperglycemia in hospitalized patients treated with gatifloxacin or levofloxacin increased 112-fold if the patients were diabetic and 10-fold if the dosage was too high for their kidneys to handle, John F. Mohr,...

U.S. system gets failing grade.(www.cmwf.org)(Brief article)
November 1, 2006... The U.S. health care system ranked 15th out of 19 countries in number of preventable deaths, according to a comparison of 37 indicators of health outcomes, quality, access, equity, and efficiency. The United States scored particularly low,...

Target opens in-house clinics.(Policy & Practice)(Brief article)
November 1, 2006... Target, the Minneapolis-based retail powerhouse, is opening in-house clinics at 8 of its 1,443 stores. The company is rolling out the concept in its corporate hometown and soon will add at least four more in that region. According to Target,...