Month: June 2022

KHN:
Some People In This Montana Mining Town Worry About The Dust Next Door 

Steve McGrath stood in an empty lot a block from his home watching for dust. In this southwestern Montana city nicknamed “The Richest Hill on Earth,” more than a century of mining left polluted soil and water that has taken decades to clean. But at that moment, looking across the road toward Butte’s last operating open-pit mine, McGrath was worried about the air. “Here comes another truck,” McGrath said, pointing to a hillside across the street as a massive dump truck unloaded ore for the mine’s crusher. A brown cloud billowed into the air. “And there’s the dust.” (Houghton, 6/8)

KHN:
Patients Seek Mental Health Care From Their Doctor But Find Health Plans Standing In The Way

When a longtime patient visited Dr. William Sawyer’s office after recovering from covid, the conversation quickly turned from the coronavirus to anxiety and ADHD. Sawyer — who has run a family medicine practice in the Cincinnati area for more than three decades — said he spent 30 minutes asking questions about the patient’s exercise and sleep habits, counseling him on breathing exercises, and writing a prescription for attention-deficit/hyperactivity disorder medication. (Pattani, 6/8)

KHN:
‘An Arm And A Leg’: Good News For Your Credit Report 

Credit reporting bureaus announced in March that they would start taking most paid medical debt off people’s credit reports. At first, we weren’t sure that would be such a huge deal. After all, the unpaid medical debt would still exist, people would still get harassed by debt collectors, or even sued over it. But it turns out, there are a bunch of reasons these changes could be life-changing, and we want to give credit (the good kind) where it’s due.  (Weissmann, 6/8)

Stat:
FDA Advisers Recommend Authorization Of Novavax’s Covid-19 Vaccine

Experts who advise the Food and Drug Administration voted overwhelmingly on Tuesday to recommend the agency issue an emergency use authorization for Novavax’s Covid-19 vaccine — a long-awaited win for a company that has struggled to get to this point. The Vaccines and Related Biological Products Advisory Committee voted 21 to 0 to recommend that the vaccine receive an EUA, with a single abstention. The strong vote belied the tenor of much of the day’s discussion, which started with one member of the committee, Eric Rubin, editor of the New England Journal of Medicine, questioning whether additional EUAs are needed when three vaccines are already in use in the country. (Branswell, 6/7)

The Washington Post:
FDA Advisers Recommend Authorizing Novavax Coronavirus Vaccine 

Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation, abstained from voting but said he was giving the vaccine a “conditional yes.” He said the vaccine was shown to be generally safe and effective when clinical trials were conducted but that “we don’t know whether that is true today.” He said it was important to monitor the vaccine’s performance as it comes into use. (Johnson and McGinley, 6/7)

Reuters:
Novavax COVID Shot, Aimed At Vaccine Skeptics, Overwhelmingly Backed By FDA Panel

The timeline for Novavax is not clear. Novavax Chief Commercial Officer John Trizzino said the agency is still reviewing documents detailing its manufacturing processes submitted last week. “We hopefully expect to have product in the U.S. in our warehouse by the end of June,” he said in an interview, adding that the company plans to ship millions of doses made by its partner, the Serum Institute of India, soon after authorization. (Erman and Mishra, 6/7)

The New York Times:
Monkeypox Can Be Airborne, Too 

The Centers for Disease Control and Prevention updated its guidance last week for travelers wishing to protect themselves against monkeypox. This was one of its recommendations: “Wear a mask. Wearing a mask can help protect you from many diseases, including monkeypox.” Late Monday night, that recommendation was deleted. However, the agency still says that in countries where monkeypox is spreading, “household contacts and health care workers” should consider wearing masks. That guideline also applies to “other people who may be in close contact with a person who has been confirmed with monkeypox.” The turnabout hints at a little-discussed aspect of the current monkeypox outbreak: The virus can be airborne, at least over short distances. (Mandavilli, 6/7)

Reuters:
U.S. CDC Removes Mask Recommendation From Monkeypox Travel Notice To Avoid Confusion 

The U.S. Centers for Disease Control and Prevention (CDC) said on Tuesday it had removed a mask recommendation from its monkeypox travel notice to avoid “confusion” over the disease, which primarily spreads through direct contact. “Late yesterday, CDC removed the mask recommendation from the monkeypox Travel Health Notice because it caused confusion,” a CDC spokesperson said on Tuesday. (6/7)

AP:
Arizona’s 1st Probable Monkeypox Case In Maricopa County

Arizona health officials announced Tuesday that they have identified the state’s first probable monkeypox case in Maricopa County. They said testing at the Arizona State Public Health Laboratory returned a presumptive positive result and confirmatory testing is underway at the Centers for Disease Control and Prevention. Officials said the case involves a man in his late 30s who is currently in isolation and recovering. (6/7)

The Hill:
Here Are The States With Monkeypox Cases

The U.S. has not reported any deaths from the monkeypox cases, and officials are working to contain cases by identifying who was exposed to the virus and getting them a vaccine. There are currently more than 30 cases in the nation. (Lonas, 6/7)

Stat:
Lessons From AIDS Crisis Guide Response To Monkeypox Outbreak 

As officials, researchers and activists scramble to control an emerging monkeypox outbreak, many are doing so with another virus constantly wedged in the back of their minds: HIV. The parallels between the two infections are limited but clear. Although the monkeypox strain now in circulation is infinitesimally milder than HIV — zero fatalities have been reported out of the more than 1,000 cases so far — it is another virus that emerged in sub-Saharan Africa and has popped up outside the continent largely in men who have sex with men. “There are, you know, echoes,” said Chris Beyrer, director of the Duke Global Health Institute. (Mast, 6/8)

Fortune:
Florida Is Once Again Becoming An Area Of Concern For COVID Cases

COVID-19 cases are once again topping 100,000 per day in the U.S., and that number could be significantly higher as the number of unreported cases grows, thanks to at-home testing. But not all areas are equal when it comes to risk levels. The Centers for Disease Control and Prevention has ranked the risk level by county through the U.S.—and, as of Tuesday, 241 counties are ranked as having high COVID-19 levels, which is determined by whichever is higher: either new hospital admissions of people with the virus, or the percentage of inpatient beds in use by COVID-19 patients. (Morris, 6/7)

AP:
Washington Hospitals Again Strained By COVID-19 Spread

Hospital officials in Washington are urging people to wear masks and warning that facilities are heading toward another COVID-19 case peak amid high spread in the community. Washington State Hospital Association CEO Cassie Sauer on Monday said at the end of last week, almost 600 people with COVID-19 were in hospitals across the state with about 20-25 patients a day on ventilators, The News Tribune reported. (6/7)

AP:
Bonus Pay Coming For Minnesota’s Frontline COVID-19 Workers 

Minnesota residents who came into work during the height of the coronavirus pandemic will soon be collecting bonus pay. Workers who are eligible for so-called hero pay can begin applying online Wednesday morning and will have up to 45 days to sign up, Minnesota Gov. Tim Walz said. The money be divided evenly, following a period for appeals. (6/7)

CBS News:
Hospital Studying Long-Term Effects Of COVID In Kids

Adriana Vaughan tested positive for COVID-19 in October 2021. Eight months later, the 12-year-old has a string of new medical issues: fatigue, headaches, stomach problems and more. Vaughan can’t even walk for six minutes without losing her breath. She says swimming, which she did before getting COVID, is also hard. … Vaughan is one of more than 70 kids being treated in the long COVID clinic at Children’s National Hospital in Washington, D.C. Dr. Alexandra Yonts, an infectious disease specialist who runs the clinic, said fatigue is the top complaint among patients young and old. (Duncan, 6/7)

CIDRAP:
COVID-19 Was Leading Cause Of Duty-Related Police Deaths In 2020 

COVID-19 caused 62{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of duty-related deaths of US police officers in the first year of the pandemic—a rate that rose to 77{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 82{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} among minority officers—according to a new study published in Policing: An International Journal. (Van Beusekom, 6/7)

CIDRAP:
Those Who Believe In COVID-19 Conspiracies May Be At Risk For Depression

People who believe in conspiracies about the COVID-19 pandemic are at an increased risk of experiencing anxiety and depression, according to new research presented at the European Congress of Psychiatry and published in Frontiers in Psychiatry. The research was based on survey results of 700 volunteers who answered a newly created COVID-19 Conspiratorial Beliefs Scale developed by researchers at several Polish universities. Participants also took the Hospital Anxiety and Depression Scale survey, as well as the Generic Conspiracist Beliefs Scale (covering topics such as aliens from other planets) to compare results. (6/7)

Milwaukee Journal Sentinel:
Wisconsin Supreme Court OKs Releasing COVID Data On Businesses

More than a year after Wisconsin’s largest business lobby sued to stop the state from releasing data on companies with COVID outbreaks, a narrowly divided Wisconsin Supreme Court on Tuesday ruled in favor of releasing the records. The majority opinion, written by Justice Rebecca Dallet, asserts that Wisconsin Manufacturers & Commerce did not have the right to challenge the state health department’s authority to release public records. The state legislature in 2003 limited when people can challenge the release of public records to a few clearly defined circumstances after a number of high profile cases in which teachers accused of having sex with students tried to stop the release of their personnel records. The slew of subsequent lawsuits bogged down the open records process in local government so much that it essentially defeated the intent of the open records law. (Chen, 6/7)

Axios:
Biden Administration Seeks To Suppress Hospital Safety Data

Consumer groups are pushing back against a Biden administration proposal that would block public access to key hospital safety data such as infection rates, falls and incidence of bed sores. Medicare is accepting comments from the public through June 17 on the rule, saying it is proposing the data suppression “due to the impact of the COVID-19 [public health emergency.]” … “The public has a right to know what happened during the pandemic. We have a right to know when lives are at risk and which hospitals did the best job of protecting their patients,” said Leah Binder, CEO of the Leapfrog Group, an organization that grades hospital care.(Reed, 6/7)

CIDRAP:
Molnupiravir Cut Need For Higher Levels Of Care In Non-Severe COVID-19

Nonhospitalized, unvaccinated COVID-19 patients who received Merck’s antiviral molnupiravir had less need for respiratory support and fewer acute-care visits than those given a placebo, finds the secondary analysis of the phase 2/3 randomized, controlled MOVe-OUT trial published today in the Annals of Internal Medicine. (6/7)

Becker’s Hospital Review:
26 Million People Stuck In Paxlovid ‘Deserts’

At-home COVID-19 treatment Paxlovid was inaccessible to more than 26 million Americans January through March, according to a recent GoodRx analysis. The pharmacy “deserts” spanned 42 percent of the nation’s counties and mainly fell in rural areas. One of the possible causes for the supply drought is the shaky test-to-treat initiative, which faces fewer COVID-19 tests and a public wary of taking a new medication. (Twenter, 6/7)

CIDRAP:
Moderna Launches Phase 3 Trial Of MRNA Flu Vaccine

Moderna today announced the launch of a phase 3 trial of its mRNA seasonal flu vaccine, which has a goal of immunizing about 6,000 adult participants in the Southern Hemisphere, which is entering its flu season. In a statement, the company said the vaccine candidate, one of several respiratory disease vaccines in development, encodes for the hemagglutinin glycoprotein of the four flu virus strains recommended by the World Health Organization. It added that the surface glycoprotein is an important target for generating broad protection against flu and is the primary target for current flu vaccines. (6/7)

Bloomberg:
New Drug Prices Soar To $180,000 A Year On 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} Annual Inflation

While gasoline and food prices soar, few products rival the inflation in prices on newly launched prescription drugs, according to a new study. The median launch price of a new drug in the US soared from $2,115 in 2008 to $180,007 in 2021, a 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} annual inflation rate over the period, researchers at Harvard-affiliated Brigham and Women’s Hospital in Boston found. Even after adjusting for factors such as drugmakers’ focus on expensive disease categories like cancer and estimated discounts that manufacturers give some purchasers, the annual inflation rate in launch prices over the period was still almost 11{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}. (Langreth, 6/7)

NBC News:
Hospitals Are Required To Post Prices For Common Procedures. Few Do.

Few hospitals are posting the prices of their common procedures online, despite a federal law that went into effect more than a year ago. The Hospital Price Transparency Law is intended to make the hidden costs of services such as X-rays, medical tests or colonoscopies clear to patients before they enter the hospital. But a study published Tuesday in the Journal of the American Medical Association added to mounting evidence that hospitals are largely ignoring the law.  (Sullivan and Dunn, 6/8)

Stat:
Study Suggests A New Harm From Hospital Mergers: Less Price Transparency

Health care economists argue hospital mergers can raise costs and lower quality. And now, a new study adds another downside: Hospitals in concentrated markets are also less likely to be transparent about their prices. Researchers pored over the websites of more than 5,200 hospitals to check on their adherence to the federal Hospital Price Transparency Final Rule, which took effect in January 2021. Their research letter, published Tuesday in the Journal of the American Medical Association, shows compliance is dismally low — less than 6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} — adding to previous research and media reports that found the same. (Bannow, 6/7)

Modern Healthcare:
FTC Takes Aim At PBM Business Practices In New Inquiry

The Federal Trade Commission will intensify its scrutiny of pharmacy benefit manager business practices, the agency announced Tuesday. The probe, which the commission unanimously approved, will focus on how vertical integration in the PBM sector affects access and pricing in the prescription drug market, according to a news release. The FTC will require the six largest PBMs to provide information about their activities. The regulator plans to send compulsory orders to CVS Health’s CVS Caremark, Cigna’s Express Scripts, UnitedHealth Group’s OptumRx, Humana, Blue Cross and Blue Shield-affiliated Prime Therapeutics, and MedImpact Healthcare Systems. CVS Caremark, Express Scripts and OptumRx collectively control about 80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the PBM market. (Goldman, 6/7)

Modern Healthcare:
California Doctors Union Avoids Strike With Tentative Contract

A union representing 1,300 resident physicians and fellows at three Los Angeles County hospitals reached a tentative contract with the county, averting a potential strike, the labor organization said Tuesday. The Committee of Interns and Residents, a local chapter of Service Employees International Union, entered additional negotiations with the county following its vote late last month to authorize a strike. No details were released on the tentative pact’s specifics or when members would vote on it but in a news release, the union said the proposal contained “significant material gains for resident physicians.” (Devereaux, 6/7)

The Boston Globe:
‘The Numbers Just Continue To Rise’: Patients Awaiting Psychiatric Treatment Crowd Emergency Rooms

On Monday, nearly all of South Shore Hospital’s pediatric emergency beds were occupied by children who were suicidal. The 10 patients, some of whom had been there 12 days or more, were waiting for a place that could take them and care for their mental health needs. Another 18 adults were in the emergency department with behavioral health issues, also waiting for beds at South Shore or another facility. One person had been there 17 days. Hospital officials throughout the state say they are seeing unprecedented volumes of behavioral health patients who are sicker than ever before, a leading contributor to emergency room crowding, which officials say has worsened in recent weeks. (Bartlett, 6/7)

The Washington Post:
‘Extreme’ Heat To Bake Texas, Southwest With Highs Topping 110 Degrees 

Temperatures are set to soar in Texas and the Desert Southwest this week, with readings topping 110 degrees and an escalating danger of heat-related illnesses. The National Weather Service is calling the heat “dangerous,” “extreme” and “excessive,” warning vulnerable populations to take steps to ensure access to cooling resources. (Cappucci, 6/7)

Axios:
Heat Waves Could Soon Have Names

There’s a growing effort to name and categorize heat waves the way we do hurricanes — to call attention to their significance, alert people to dangerous temperatures and prod public officials into action. Heat waves are the deadliest type of weather emergency in the U.S. They’re bigger killers than floods, tornadoes or hurricanes — and they’re growing in frequency and intensity due to global warming. (Kingson, 6/8)

Billings Gazette:
Voters Want To Keep Recreational Pot, According To Early Returns

Yellowstone County voters want to keep their access to local recreational marijuana dispensaries. In the first batch of results from Tuesday’s election, 21,903 voters opted to keep recreational marijuana sales legal in Yellowstone County compared to 15,869 who voted to ban sales. Voters were asked whether to overturn legalized recreational marijuana sales in Yellowstone County following a move in December by Yellowstone County commissioners to place the question on the June ballot. It’s the third time since November 2020 that Billings voters have cast a ballot asking about recreational marijuana. Montana voters in 2020 overwhelmingly approved legalizing recreational marijuana; in Yellowstone County the vote was more narrow, 50.7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} to 49.3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} in favor, a difference of roughly 1,100 votes. (Rogers, 6/7)

Dallas Morning News:
Garland ISD Will Clean Up Soil With High Levels Of Arsenic At Middle School Campus

Garland ISD has plans to remove soil near Sam Houston Middle School after a third-party contractor report found some areas with high levels of arsenic. On Friday, Garland ISD’s executive director of facilities and maintenance, Paul Gonzales, sent out a letter to families attending the school announcing that there would be a cleanup process this summer. The report, which The Dallas Morning News obtained via an open records request, comes almost a year after the EPA alerted Garland ISD about its findings of lead contaminated soil at Park Crest Elementary, which is directly across the street from Sam Houston. The EPA began a cleanup process to remove the lead contaminated soil on district property and in the surrounding neighborhood last August. (D’Annunzio, 6/7)

Oklahoman:
Oklahoma City-County Health Department To Offer Free Mammograms On June 10

The Oklahoma City-County Health Department will be offering free mammograms on Friday, June 10. The event is in partnership with OU Health, Stephenson Cancer Center and The Market at Eastpoint, 1708 NE 23. The mobile mammography unit will be at The Market to screen women over the age of 40. All services are free, and if any abnormalities are found, diagnostic testing and follow-up will also be offered at no cost. (6/7)

Stateline:
One Region Led A 13-State Pandemic Baby Boomlet

New England has seen an unusual uptick in births during the coronavirus pandemic as more highly educated residents, especially those in their 30s, seized working from home as an opportunity to start a family. All six New England states were among the 13 states where births increased between 2019 and 2021. New Hampshire and Tennessee were the only states with more births last year than in 2014, the last time births rose nationally. The New England baby boomlet is notable in a region with the lowest birth rates in the nation—and it contrasts with a long-term national decline in births. (Henderson, 6/7)

AP:
Police: DNA Technology Connects Man To Florida Serial Rapes 

Advanced DNA technology helped detectives link the cases of six women to a man accused of being the “pillowcase rapist” for a string of rapes back in the 1980s.Robert Koehler is currently jailed in neighboring Miami-Dade County, where he faces charges for assaulting a woman in the early ’80s as well, Broward County Sheriff Gregory Tony said in a Tuesday morning news conference. Authorities believe Koehler, 62, may have committed 40 to 45 rapes, terrifying victims by breaking into their homes at night, the sheriff said. (Frisaro, 6/7)

CBS News:
Jif Peanut Butter Recalls Now Include Ice Cream, Candy And Chicken Salad

Add peanut butter cup ice cream to a growing list of recalled food made with Jif peanut butter that is linked to an outbreak of salmonella that has sickened 16 people in the U.S. Americans are being cautioned against eating a range of baked goods, sandwiches, candy, trail mix and ready-to-eat salad products made with the recalled Jif peanut butter, as snacks are pulled from stores, vending machines and restaurants nationwide amid a multi-state outbreak of salmonella. (Gibson, 6/7)

NBC News:
Family Sues Meta, Blames Instagram For Daughter’s Eating Disorder And Self-Harm

A preteen girl’s “addictive” use of Instagram resulted in an eating disorder, self-harm and thoughts of suicide over several years, according to a lawsuit against the platform’s parent company, Meta. The lawsuit, which was filed in U.S. District Court for the Northern District of California late Monday, heavily cites the Facebook Papers, a trove of internal Meta research documents leaked last fall that revealed that the tech giant knew Instagram was worsening body-image and other mental-health issues among teenage girls in particular. (Cook, 6/7)

The Washington Post:
Coyote Killed By Cop After Biting People In Fairfax Tests Positive For Rabies

A coyote that bit three people before it was fatally shot by a police officer in Fairfax County has tested positive for rabies, and residents who were bitten are urged to get medical treatment. Officials with the county’s health department said a lab test performed Monday confirmed that the coyote had rabies. (Hedgpeth, 6/7)

AP:
Some Cancer Patients Can Skip Treatments, 2 Studies Show

After surgery, some cancer patients can safely skip radiation or chemotherapy, according to two studies exploring shorter, gentler cancer care. Researchers are looking for ways to precisely predict which cancer patients can avoid unneeded treatment to cut down on harmful side effects and unnecessary costs. One new study used a blood test to determine which colon cancer patients could skip chemotherapy after surgery. Another suggests some low-risk breast cancer patients can omit radiation after lumpectomy. (Johnson, 6/7)

Reuters:
Sanofi’s Dupixent Gets U.S. Approval To Treat Eczema In Young Children

The U.S. Food and Drug Administration approved the use of Sanofi and Regeneron Pharmaceuticals Inc’s anti-inflammation drug Dupixent to treat eczema in young children, the two companies said on Tuesday. Dupixent is now the first approved treatment for moderate-to-severe eczema in young children, Sanofi and Regeneron said. (6/7)

CNN:
Prescription Cannabis Products With More THC May Ease Chronic Pain, At Least A Little, Study Finds 

People who suffer from chronic pain may find small-to-moderate pain relief for the short-term when using certain prescription cannabis products with higher THC to CBD levels, but there are some worrisome side effects, according to new research. Tetrahydrocannabinol, or THC, is the chemical compound in the marijuana plant that makes you high. Cannabidiol, or CBD, is the second most prevalent active chemical in cannabis, but it does not make you high. Both have been associated with pain relief. “The findings are in line with what we know,” said Yasmin Hurd, a professor of pharmacological sciences, neuroscience and psychiatry at the Icahn School of Medicine at Mount Sinai in New York City. She was not involved with the study. (LaMotte, 6/8)

The Washington Post:
Type 2 Diabetes May Accelerate Brain Function Decline As People Age

In older people with Type 2 diabetes, the brain appears to age at an accelerated rate — about 26 percent faster than normal, according to research published in the journal eLife. Relying on brain scans, brain functioning tests and other data from 20,314 people, ages 50 to 80, the researchers compared neurological changes in those who did and did not have Type 2 diabetes. In both groups, they found declines in executive functions such as working memory, learning and flexible thinking, as well as declines in brain processing speed. (Searing, 6/7)

The Washington Post:
‘Needle Spiking’ Reports Grow In France, Belgium And Britain

She had eagerly looked forward to going home for the holidays and reuniting with friends over dinner and drinks. Instead, Eva Keeling, 19, says, she wound up injected by a stranger with a needle, leaving her unable to speak or function while at a bar in her hometown of Stafford, in northern England. “We went outside [the bar] for some fresh air … then I ended up losing all control of my body, the ability to walk, hold my head up, I couldn’t talk — I was projectile vomiting everywhere,” Keeling told The Washington Post. (Suliman and Francis, 6/7)

Reuters:
Chernobyl Radiation Detectors Back Online, Levels Normal — IAEA

Radiation detectors in the Exclusion Zone around Ukraine’s defunct Chernobyl nuclear power plant are back online for the first time since Russia seized the area on Feb. 24, and radiation levels are normal, the U.N. nuclear watchdog said on Tuesday. “Most of the 39 detectors sending data from the Exclusion Zone … are now visible on the IRMIS (International Radiation Monitoring Information System) map,” the International Atomic Energy Agency said in a statement. “The measurements received so far indicated radiation levels in line with those measured before the conflict.” (6/7)

NBC News:
Ukraine Sounds Alarm About Possible Cholera Outbreak In Russian-Occupied Mariupol

Mariupol, the Ukrainian city relentlessly bombed and besieged by Russian forces for months, could now be facing a deadly cholera outbreak, local officials have warned. An adviser to the occupied port city’s mayor said Tuesday that its drinking water had been contaminated by decomposing garbage and corpses, increasing the risk of a cholera outbreak. (Talmazan, 6/7)