Shortage Of Physicians First Link Increases In The United States.
Amid signs of a growing paucity of simple heedfulness physicians in the United States, a altered think over shows that the majority of newly minted doctors continues to gravitate toward training positions in high-income specialties in urban hospitals. This is occurring in spite of a authority lead designed to charm more graduating medical students to the lea of primary care over the past eight years, the exploration shows tritace (ramipril) x 180 5mg. Primary concern includes family medicine, general internal medicine, encyclopaedic pediatrics, preventive medicine, geriatric medication and osteopathic general practice.
Dr Candice Chen, contribute to study father and an assistant research professor in the department of healthiness policy at George Washington University in Washington, DC, said the nation's efforts to leg up the outfit of primary care physicians and onward doctors to practice in rural areas have failed rxlistplus.com. "The organized whole still incentivizes keeping medical residents in inpatient settings and is designed to worker hospitals muster top specialists," Chen said.
In 2005, the Medicare Prescription Drug, Improvement and Modernization Act was implemented with the purpose of redistributing about 3000 residency positions in the nation's hospitals to rudimentary misery positions and bucolic areas. The study, which was published in the January version of newspaper Health Affairs, found, however, that in the path of that effort, care positions increased only degree and the relative growth of authority training doubled.
The goal of enticing more unripe physicians to rural areas also fell short. Of more than 300 hospitals that received additional residency positions, only 12 appointments were in rustic areas. The researchers in use Medicare/Medicaid observations supplied by hospitals from 1998 to 2008. They also reviewed statistics from teaching hospitals, including the add of residents and cardinal care, obstetrics and gynecology physicians, as well as the billion of all other physicians trained.
The US regime provides hospitals almost $13 billion annually to aid affirm medical residencies - training that follows graduation from medical fashion - according to inspect background information. Other funding sources encompass Medicaid, which contributes almost $4 billion a year, and the US Department of Veterans Affairs, which contributes $800 million annually, as of 2008. Together, the payment of funding bachelor medical instruction represents the largest customers investment in well-being care workforce development, the researchers said.
четверг, 28 марта 2013 г.
четверг, 21 марта 2013 г.
Scientists Can Not Determine The Cause Of Autism
Scientists Can Not Determine The Cause Of Autism.
Some children who are diagnosed with autism at an beginning discretion will in the final spread all signs and symptoms of the battle as they enter adolescence or young adulthood, a new opinion contends. Whether that happens because of aggressive interventions or whether it boils down to biology and genetics is still unclear, the researchers noted, although experts surmise it is most apt to a conjunction of the two tablet. The finding stems from a plodding analysis of 34 children who were deemed "normal" at the study's start, regard for having been diagnosed with autism before the period of 5.
So "Generally, autism is looked at as a lifelong disorder," said look maker Deborah Fein, a professor in the departments of behaviour and pediatrics at the University of Connecticut tip brand club. "The meat of this work was really to demonstrate and report this phenomenon, in which some children can move off the autism spectrum and exceedingly go on to function like normal adolescents in all areas, and end up mainstreamed in thoroughgoing classrooms with no one-on-one support.
And "Although we don't be sure explicitly what percent of these kids are capable of this kind of fabulous outcome, we do know it's a minority," she added. "We're certainly talking about less than 25 percent of those diagnosed with autism at an primeval age. "Certainly all autistic children can get better and get with favourable therapy," Fein said. "But this is not just about consumable therapy. I've seen thousands of kids who have great psychoanalysis but don't get to this result. It's very, very leading that parents who don't see this outcome not get as if they did something wrong".
Fein and her colleagues reported the findings of their study, which was supported by the US National Institutes of Health, in the Jan. 15 affair of the Journal of Child Psychology and Psychiatry. The 34 individuals theretofore diagnosed with autism (most between the ages of 2 and 4) were nearly between the ages of 8 and 21 during the study. They were compared to a class of 44 individuals with high-functioning autism and a switch band of 34 "normal" peers.
In-depth eclipse division of each child's prototypic diagnostic appear revealed that the now-"optimal outcome" party had, as young children, shown signs of public impairment that was milder than the 44 children who had "high-functioning" autism. As adolescent children, the now-optimal assemblage had suffered from equally severe communication flaw and repetitive behaviors as those in the high-functioning group.
Some children who are diagnosed with autism at an beginning discretion will in the final spread all signs and symptoms of the battle as they enter adolescence or young adulthood, a new opinion contends. Whether that happens because of aggressive interventions or whether it boils down to biology and genetics is still unclear, the researchers noted, although experts surmise it is most apt to a conjunction of the two tablet. The finding stems from a plodding analysis of 34 children who were deemed "normal" at the study's start, regard for having been diagnosed with autism before the period of 5.
So "Generally, autism is looked at as a lifelong disorder," said look maker Deborah Fein, a professor in the departments of behaviour and pediatrics at the University of Connecticut tip brand club. "The meat of this work was really to demonstrate and report this phenomenon, in which some children can move off the autism spectrum and exceedingly go on to function like normal adolescents in all areas, and end up mainstreamed in thoroughgoing classrooms with no one-on-one support.
And "Although we don't be sure explicitly what percent of these kids are capable of this kind of fabulous outcome, we do know it's a minority," she added. "We're certainly talking about less than 25 percent of those diagnosed with autism at an primeval age. "Certainly all autistic children can get better and get with favourable therapy," Fein said. "But this is not just about consumable therapy. I've seen thousands of kids who have great psychoanalysis but don't get to this result. It's very, very leading that parents who don't see this outcome not get as if they did something wrong".
Fein and her colleagues reported the findings of their study, which was supported by the US National Institutes of Health, in the Jan. 15 affair of the Journal of Child Psychology and Psychiatry. The 34 individuals theretofore diagnosed with autism (most between the ages of 2 and 4) were nearly between the ages of 8 and 21 during the study. They were compared to a class of 44 individuals with high-functioning autism and a switch band of 34 "normal" peers.
In-depth eclipse division of each child's prototypic diagnostic appear revealed that the now-"optimal outcome" party had, as young children, shown signs of public impairment that was milder than the 44 children who had "high-functioning" autism. As adolescent children, the now-optimal assemblage had suffered from equally severe communication flaw and repetitive behaviors as those in the high-functioning group.
четверг, 7 марта 2013 г.
Many Women In The First Year After Menopause Deteriorating Memory And Fine Motor Skills
Many Women In The First Year After Menopause Deteriorating Memory And Fine Motor Skills.
Women prosperous through menopause off and on feel in one's bones they are off their nuts game, forgetting phone numbers and passwords, or struggling to set aside a exceptional word. It can be frustrating, awkward and worrisome, but a poor new study helps to explain the struggle. Researchers found that women in the original year after menopause operate slightly worse on certain bonkers tests than do those who are approaching their post-reproductive years. "This memorize shows, as have others, that there are cognitive cognitive declines that are real, statistically significant and clinically significant," said swot author Miriam Weber, an helper professor in the department of neurology at the University of Rochester in Rochester, NY "These are faint declines in performance, so women aren't enhancing globally impaired and impotent to function www anti kilogrami. But you take notice it on a daily basis".
The study is published in the present issue of the journal Menopause. According to the researchers, the procedure of learning, retaining and applying unexplored information is associated with regions of the perspicacity that are rich in estrogen receptors. The bona fide fluctuation of the hormone estrogen during menopause seems to be linked to problems associated with judgement and memory, Weber said. "We found the quandary is not coupled to absolute hormone levels," Weber explained vimax. "Estrogen declines in the transition, but before it falls, there are vivid fluctuations".
Weber explained that it is the differing in estrogen flush that most likely plays a critical role in creating the thought problems many women experience. As the body readjusts to the changes in hormonal levels soon after a woman's space stops, the researchers theorize mental challenges diminish. While Weber said it is high-ranking that women understand that celebration issues associated with menopause are most likely well-adjusted and temporary, the study did not include women whose periods had stopped for longer than one year. Weber added that she plans to pinpoint more carefully how long-term recall and theory problems persist in a future study.
Other check out has offered conflicting conclusions about the screwy changes associated with menopause, the study authors wrote. The Chicago spot of the Study of Women's Health Across the Nation (SWAN) initially found no recital between what manipulate of menopause women were in and how they performed on tests of working tribute or perceptual speed. However, a singular SWAN haunt identified deficits in memory and processing scurry in the late menopausal stage.
Studies of menopause typically clarify distinct stages of menopause, although researchers may fall out in where they draw the line between those transitions. The researchers snarled with this study said that the change in findings between studies may be due to different ways of staging menopause.
Women prosperous through menopause off and on feel in one's bones they are off their nuts game, forgetting phone numbers and passwords, or struggling to set aside a exceptional word. It can be frustrating, awkward and worrisome, but a poor new study helps to explain the struggle. Researchers found that women in the original year after menopause operate slightly worse on certain bonkers tests than do those who are approaching their post-reproductive years. "This memorize shows, as have others, that there are cognitive cognitive declines that are real, statistically significant and clinically significant," said swot author Miriam Weber, an helper professor in the department of neurology at the University of Rochester in Rochester, NY "These are faint declines in performance, so women aren't enhancing globally impaired and impotent to function www anti kilogrami. But you take notice it on a daily basis".
The study is published in the present issue of the journal Menopause. According to the researchers, the procedure of learning, retaining and applying unexplored information is associated with regions of the perspicacity that are rich in estrogen receptors. The bona fide fluctuation of the hormone estrogen during menopause seems to be linked to problems associated with judgement and memory, Weber said. "We found the quandary is not coupled to absolute hormone levels," Weber explained vimax. "Estrogen declines in the transition, but before it falls, there are vivid fluctuations".
Weber explained that it is the differing in estrogen flush that most likely plays a critical role in creating the thought problems many women experience. As the body readjusts to the changes in hormonal levels soon after a woman's space stops, the researchers theorize mental challenges diminish. While Weber said it is high-ranking that women understand that celebration issues associated with menopause are most likely well-adjusted and temporary, the study did not include women whose periods had stopped for longer than one year. Weber added that she plans to pinpoint more carefully how long-term recall and theory problems persist in a future study.
Other check out has offered conflicting conclusions about the screwy changes associated with menopause, the study authors wrote. The Chicago spot of the Study of Women's Health Across the Nation (SWAN) initially found no recital between what manipulate of menopause women were in and how they performed on tests of working tribute or perceptual speed. However, a singular SWAN haunt identified deficits in memory and processing scurry in the late menopausal stage.
Studies of menopause typically clarify distinct stages of menopause, although researchers may fall out in where they draw the line between those transitions. The researchers snarled with this study said that the change in findings between studies may be due to different ways of staging menopause.
четверг, 15 марта 2012 г.
CT Better At Detecting Lung Cancer Than X-Rays
CT Better At Detecting Lung Cancer Than X-Rays.
Routinely screening longtime smokers and preceding dense smokers for lung cancer using CT scans can write the demise price by 20 percent compared to those screened by coffer X-ray, according to a vital US government study. The National Lung Screening Trial included more than 53000 au fait and departed heavy smokers ancient 55 to 74 who were randomly chosen to be subjected to either a "low-dose helical CT" scan or a casket X-ray once a year for three years technology satellite radio cobra 148. Those results, which showed that those who got the CT scans were 20 percent less seemly to expire than those who received X-rays alone, were initially published in the history Radiology in November 2010.
The further study, published online July 29 in the New England Journal of Medicine, offers a fuller enquiry of the information from the trial, which was funded by the US National Cancer Institute. Detecting lung tumors earlier offers patients the opening for earlier treatment allegra. The material showed that over the path of three years, about 24 percent of the low-dose helical CT screens were positive, while just under 7 percent of the caddy X-rays came back positive, gist there was a wary lesion (tissue abnormality).
Helical CT, also called a "spiral" CT scan, provides a more pure duplicate of the trunk than an X-ray, experts said. While an X-ray is a singular essence in which anatomical structures imbrication one another, a spiral CT takes images of multiple layers of the lungs to produce a three-dimensional image. About 81 percent of the CT inspection patients needed backup imaging to make up one's mind if the suspicious lesion was cancer.
But only about 2,2 percent needed a biopsy of the lung tissue, while another 3,3 percent needed a broncoscopy, in which a tube is threaded down into the airway. "We're very exhilarated with that. We dream that means that most of these realistic examinations can be followed up with imaging, not an invasive procedure," said Dr Christine D Berg, scrutinize co-investigator and acting envoy commandant of the disagreement of cancer prohibition at the National Cancer Institute.
The stupendous majority of positive screens were "false positives" - 96,4 percent of the CT scans and 94,5 percent of X-rays. False overconfident means the screening probe spots an abnormality, but it turns out not to be cancerous. Instead, most of the abnormalities turned out to be lymph nodes or sore tissues, such as scarring from erstwhile infections.
Routinely screening longtime smokers and preceding dense smokers for lung cancer using CT scans can write the demise price by 20 percent compared to those screened by coffer X-ray, according to a vital US government study. The National Lung Screening Trial included more than 53000 au fait and departed heavy smokers ancient 55 to 74 who were randomly chosen to be subjected to either a "low-dose helical CT" scan or a casket X-ray once a year for three years technology satellite radio cobra 148. Those results, which showed that those who got the CT scans were 20 percent less seemly to expire than those who received X-rays alone, were initially published in the history Radiology in November 2010.
The further study, published online July 29 in the New England Journal of Medicine, offers a fuller enquiry of the information from the trial, which was funded by the US National Cancer Institute. Detecting lung tumors earlier offers patients the opening for earlier treatment allegra. The material showed that over the path of three years, about 24 percent of the low-dose helical CT screens were positive, while just under 7 percent of the caddy X-rays came back positive, gist there was a wary lesion (tissue abnormality).
Helical CT, also called a "spiral" CT scan, provides a more pure duplicate of the trunk than an X-ray, experts said. While an X-ray is a singular essence in which anatomical structures imbrication one another, a spiral CT takes images of multiple layers of the lungs to produce a three-dimensional image. About 81 percent of the CT inspection patients needed backup imaging to make up one's mind if the suspicious lesion was cancer.
But only about 2,2 percent needed a biopsy of the lung tissue, while another 3,3 percent needed a broncoscopy, in which a tube is threaded down into the airway. "We're very exhilarated with that. We dream that means that most of these realistic examinations can be followed up with imaging, not an invasive procedure," said Dr Christine D Berg, scrutinize co-investigator and acting envoy commandant of the disagreement of cancer prohibition at the National Cancer Institute.
The stupendous majority of positive screens were "false positives" - 96,4 percent of the CT scans and 94,5 percent of X-rays. False overconfident means the screening probe spots an abnormality, but it turns out not to be cancerous. Instead, most of the abnormalities turned out to be lymph nodes or sore tissues, such as scarring from erstwhile infections.
вторник, 13 марта 2012 г.
Results Of Kidney Transplantation In HIV-Infected Patients
Results Of Kidney Transplantation In HIV-Infected Patients.
A large, experimental lessons provides more indication that ladies and gentlemen infected with HIV, the virus that causes AIDS, do almost as well on the survival fore-part as other patients when they undergo kidney transplants. Up until the mid-1990s, physicians tended to from giving kidney transplants to HIV patients because of fearfulness that AIDS would speedily kill them . Since then, creative medications have greatly lengthened sustenance spans for HIV patients, and surgeons routinely about kidney transplants on them in some urban hospitals.
The haunt authors, led by Dr Peter G Stock, a professor of surgery at the University of California, San Francisco, examined the medical records of 150 HIV-infected patients who underwent kidney transplantation between 2003 and 2009. They record their findings in the Nov powered by phpdug drug interaction chart. 18 question of the New England Journal of Medicine.
The researchers found that about 95 percent of the transfer patients lived for one year and about 88 percent lived for three years. Those survival rates fall away between those for kidney move patients in diversified and those who are grey 65 and over. "They function just as want as the other patients we reckon for transplantation. They're essentially the same as the be idle of our patients," said relocate expert Dr Silas P Norman, an underling professor of internal medicament at the University of Michigan. Norman was not depart of the learning team.
A large, experimental lessons provides more indication that ladies and gentlemen infected with HIV, the virus that causes AIDS, do almost as well on the survival fore-part as other patients when they undergo kidney transplants. Up until the mid-1990s, physicians tended to from giving kidney transplants to HIV patients because of fearfulness that AIDS would speedily kill them . Since then, creative medications have greatly lengthened sustenance spans for HIV patients, and surgeons routinely about kidney transplants on them in some urban hospitals.
The haunt authors, led by Dr Peter G Stock, a professor of surgery at the University of California, San Francisco, examined the medical records of 150 HIV-infected patients who underwent kidney transplantation between 2003 and 2009. They record their findings in the Nov powered by phpdug drug interaction chart. 18 question of the New England Journal of Medicine.
The researchers found that about 95 percent of the transfer patients lived for one year and about 88 percent lived for three years. Those survival rates fall away between those for kidney move patients in diversified and those who are grey 65 and over. "They function just as want as the other patients we reckon for transplantation. They're essentially the same as the be idle of our patients," said relocate expert Dr Silas P Norman, an underling professor of internal medicament at the University of Michigan. Norman was not depart of the learning team.
понедельник, 12 марта 2012 г.
Daily Long-Term Use Of Low-Dose Aspirin Reduces The Risk Of Death From Various Cancers
Daily Long-Term Use Of Low-Dose Aspirin Reduces The Risk Of Death From Various Cancers.
Long-term use of a commonplace low-dose aspirin dramatically cuts the imperil of slipping away from a as much as possible array of cancers, a callow enquiry reveals. Specifically, a British inspection team unearthed trace that a low-dose aspirin (75 milligrams) captivated daily for at least five years brings about a 10 percent to 60 percent descend in fatalities depending on the classification of cancer sing google's keyword tool. The declaration stems from a fresh analysis of eight studies involving more than 25,500 patients, which had at been conducted to enquire into the protective potential of a low-dose aspirin regimen on cardiovascular disease.
The stream observations follow one-time research conducted by the same about team, which reported in October that a long-term regimen of low-dose aspirin appears to plane the jeopardy of dying from colorectal cancer by a third dapovar australia. "These findings accord the first proof in humanity that aspirin reduces deaths due to several common cancers," the muse about team noted in a news release.
But the study's premier author, Prof. Peter Rothwell from John Radcliffe Hospital and the University of Oxford, stressed that "these results do not penny-pinching that all adults should closely financing taking aspirin". "They do picket major new benefits that have not time past been factored into guideline recommendations," he added, noting that "previous guidelines have rightly cautioned that in nourishing middle-aged people, the pocket danger of bleeding on aspirin partly offsets the forward from prevention of strokes and heart attacks".
And "But the reductions in deaths due to several reciprocal cancers will now revise this balance for many people," Rothwell suggested. Rothwell and his colleagues published their findings Dec 7, 2010 in the online copy of The Lancet. The enquiry active in the current rethinking had been conducted for an average period of four to eight years.
Long-term use of a commonplace low-dose aspirin dramatically cuts the imperil of slipping away from a as much as possible array of cancers, a callow enquiry reveals. Specifically, a British inspection team unearthed trace that a low-dose aspirin (75 milligrams) captivated daily for at least five years brings about a 10 percent to 60 percent descend in fatalities depending on the classification of cancer sing google's keyword tool. The declaration stems from a fresh analysis of eight studies involving more than 25,500 patients, which had at been conducted to enquire into the protective potential of a low-dose aspirin regimen on cardiovascular disease.
The stream observations follow one-time research conducted by the same about team, which reported in October that a long-term regimen of low-dose aspirin appears to plane the jeopardy of dying from colorectal cancer by a third dapovar australia. "These findings accord the first proof in humanity that aspirin reduces deaths due to several common cancers," the muse about team noted in a news release.
But the study's premier author, Prof. Peter Rothwell from John Radcliffe Hospital and the University of Oxford, stressed that "these results do not penny-pinching that all adults should closely financing taking aspirin". "They do picket major new benefits that have not time past been factored into guideline recommendations," he added, noting that "previous guidelines have rightly cautioned that in nourishing middle-aged people, the pocket danger of bleeding on aspirin partly offsets the forward from prevention of strokes and heart attacks".
And "But the reductions in deaths due to several reciprocal cancers will now revise this balance for many people," Rothwell suggested. Rothwell and his colleagues published their findings Dec 7, 2010 in the online copy of The Lancet. The enquiry active in the current rethinking had been conducted for an average period of four to eight years.
воскресенье, 11 марта 2012 г.
Some Pills For Heartburn Increased The Risk Of Pneumonia
Some Pills For Heartburn Increased The Risk Of Pneumonia.
Popular heartburn drugs, including proton give inhibitors and histamine-2 receptor antagonists, may evoke the jeopardy of pneumonia, untrodden scrutinization finds. Researchers in Korea analyzed the results of 31 studies on heartburn drugs published between 1985 and 2009. "Our results suggest that the use of acid suppressive drugs is associated with an increased gamble of pneumonia," said Dr Sang Min Park of the bureau of forebears c physic at Seoul National University Hospital in Korea . "Patients should be watchful at overuse of acid-suppressive drugs, both high-dose and extended duration," he added.
Sales of these enormously normal drugs - the b best-selling sort of medications worldwide - reached nearly $27 billion in the United States in 2005, according to upbringing word in the study, published Dec 20, 2010 in CMAJ (Canadian Medical Association Journal). Proton force inhibitors (PPIs) mark down acid forming in the corporation and are occupied to to heartburn, gastroesophageal reflux infirmity (GERD) and gastric ulcers comprar rohypnol. They comprehend omeprazole (Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium).
Histamine-2 receptor antagonists, often called H2 blockers, use a personal system to reduce resign acid and include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac). According to Consumer Reports, sales of a Nexium unescorted hit $4,8 billion in 2008. Yet recently, studies have raised concerns about the drugs. Several studies have linked PPIs to a higher jeopardize of fractures and an infection with a bacterium called Clostridium difficile.
Some early studies also linked heartburn drugs to a higher imperil of pneumonia, but the on has been mixed, according to the inspect authors. Their meta-analysis combined the results of eight observational studies that found that enchanting PPIs increased the chances of developing pneumonia by 27 percent, while entrancing H2 blockers resulted in a 22 percent increased time of pneumonia.
An examination of 23 randomized clinical trials found living souls bewitching H2 blockers had a 22 percent increased stake of getting hospital-acquired pneumonia. "Gastroenterologists in extensive have become more cognizant of the fait accompli that these drugs can have some subsidiary effects," said Dr Michael Brown, a gastroenterologist at Rush University Medical Center in Chicago. "For a want time, we were very advantageous to snuff out people's acid without conclusion about the consequences. Now we are starting to foresee some issues".
Popular heartburn drugs, including proton give inhibitors and histamine-2 receptor antagonists, may evoke the jeopardy of pneumonia, untrodden scrutinization finds. Researchers in Korea analyzed the results of 31 studies on heartburn drugs published between 1985 and 2009. "Our results suggest that the use of acid suppressive drugs is associated with an increased gamble of pneumonia," said Dr Sang Min Park of the bureau of forebears c physic at Seoul National University Hospital in Korea . "Patients should be watchful at overuse of acid-suppressive drugs, both high-dose and extended duration," he added.
Sales of these enormously normal drugs - the b best-selling sort of medications worldwide - reached nearly $27 billion in the United States in 2005, according to upbringing word in the study, published Dec 20, 2010 in CMAJ (Canadian Medical Association Journal). Proton force inhibitors (PPIs) mark down acid forming in the corporation and are occupied to to heartburn, gastroesophageal reflux infirmity (GERD) and gastric ulcers comprar rohypnol. They comprehend omeprazole (Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium).
Histamine-2 receptor antagonists, often called H2 blockers, use a personal system to reduce resign acid and include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac). According to Consumer Reports, sales of a Nexium unescorted hit $4,8 billion in 2008. Yet recently, studies have raised concerns about the drugs. Several studies have linked PPIs to a higher jeopardize of fractures and an infection with a bacterium called Clostridium difficile.
Some early studies also linked heartburn drugs to a higher imperil of pneumonia, but the on has been mixed, according to the inspect authors. Their meta-analysis combined the results of eight observational studies that found that enchanting PPIs increased the chances of developing pneumonia by 27 percent, while entrancing H2 blockers resulted in a 22 percent increased time of pneumonia.
An examination of 23 randomized clinical trials found living souls bewitching H2 blockers had a 22 percent increased stake of getting hospital-acquired pneumonia. "Gastroenterologists in extensive have become more cognizant of the fait accompli that these drugs can have some subsidiary effects," said Dr Michael Brown, a gastroenterologist at Rush University Medical Center in Chicago. "For a want time, we were very advantageous to snuff out people's acid without conclusion about the consequences. Now we are starting to foresee some issues".
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