Category Archives: Senior Living

VCAAA fall prevention programs

The Ventura County Area Agency on Aging and the Ventura County Elderly Fall Prevention Coalition’s award-winning Fall Prevention Program has a new set of classes beginning soon around the county.

Oxnard

Stepping On – Oxnard Performing Arts Center – Tuesdays – March 21 through May 2 – 1 p.m. to 3 p.m.

Tai Chi: Moving for Better Balance – Oxnard Performing Arts Center – Tuesdays & Thursdays – April 11 through June 29 – 9 a.m to 10:30 a.m. OR 10:45 a.m. to 12:15 p.m.

Ventura

Tai Chi: Moving for Better Balance – County of Ventura California Room – Wednesdays & Fridays – April 12 through June 30 – 9 a.m to 10:30 a.m. OR 10:45 a.m. to 12:15 p.m.

Tai Chi: Moving for Better Balance – Community Presbyterian Church – Wednesdays & Fridays – April 12 through June 30 – 10 a.m to 11:30 a.m.

Tai Chi: Moving for Better Balance – Ventura Church of Christ – Wednesdays & Fridays – April 12 through June 30 – 10:45 a.m to 12:15 p.m.

Classes, which are free, are designed for individuals 60 and up. Please click on the PDF for additional information, or visit vcaaa.org/falls. To register for most classes, call the VCAAA at (805) 477-7300, option 6, or email [email protected]. For the Tai Chi class being hosted by HELP of Ojai, call (805) 646-5122. For A Matter of Balance being hosted by the Simi Valley Senior Center, call (805) 583-6363.

A Matter of Balance is designed for those 60 and older who are inactive with poor balance, who have fallen, and who may have developed a fear of falling. Participants should expect to begin an easy-to-do regimen to improve balance, strength, flexibility and self-confidence. This class is held once a week for eight weeks and includes chair-based exercises.

Stepping On is designed for individuals who have fallen or who are fearful of falling. Participants have access to a physical therapist who teaches strength and balance exercises, a vision expert, a public safety expert, and a pharmacist who will discuss fall risks associated with certain medications.

Tai Chi: Moving for Better Balance is an exercise program developed especially for older adults using modified practices designed to improve and strengthen balance and mobility. Classes are intended for beginners. Canes and walkers are welcome. This class is proven to reduce falls by 55 percent.

Individuals concerned about falls or those who have recently experienced a fall, as well as those who are interested in improving balance, flexibility, and strength, are encouraged to participate. Nationally recognized research shows that one in four adults over the age of 65, and half of the population over the age of 75, fall each year. One out of every five falls results in a serious injury, and about three million older people are treated at emergency departments for fall injuries each year. Approximately 32,000 older adults die each year as a result of falls.

The Ventura County Area Agency on Aging, an agency of the County of Ventura, is charged with the responsibility of promoting, developing, and implementing a comprehensive coordinated system of care that enables older individuals, children and adults with disabilities, and their caregivers to live in a community-based setting. The VCAAA advocates for the needs of those 60 years and older in the county, providing leadership and promoting citizen involvement in the planning process as well as in the delivery of services.

Spring Has Sprung, Let’s Make Your Workouts Fun!

by Leslie Sokol

No matter your age, it’s never too late to start an exercise program. As we age, our muscle function can decline, our energy can decrease, and our attention span can become limited. The best way to counteract these things and build up your confidence and enthusiasm is to be active both physically and mentally.

Want a healthy and fun way to do that? Join a group dance or fitness class. It’s fun to be with your peers and it’s a great opportunity to be active and social. You will feel like you belong to something and are with people who enjoy similar interests. Workout classes help build your confidence and self-esteem, create a positive attitude, and keep you motivated. As I say to my students, “We are all in this together”.

You will want to find a class that incorporates the three essential components of total fitness — stretching, strengthening and aerobics. However, you don’t need to wait for a class to get started! Here are some sample exercises for each component:

  • Stretching: Warm-up and cool down exercises help reduce muscle soreness and lessen your risk of injury. A simple way to get started is to begin by either standing or sitting in a chair and bending your waist side to side along with moving your arms side to side. Do this for 1 to 2 minutes.
  • Strengthening: There are many simple exercises that can help you build muscle mass and firm and tone your body. One of the easiest exercises is simple bicep curls. Use light dumbbells or fill up two water bottles and hold one in each hand. While standing or seated, extend both arms along your side with a slight bend in your elbow, keeping your wrists straight and your palms facing toward you. Keeping your arms at your sides, slowly curly the weights up and exhale as you bring them up. Then inhale as you slower lower the weights back down. That is considered one rep. Try to complete 8-12 reps, rest for 1 minutes and then do a second set.
  • Aerobic: This refers to any type of exercise that utilizes your heart and lungs. Walking is the most basic example of this. If you’re just getting started, concentrate on walking for a few minutes, gradually increasing your distance and speed as you grow stronger. Other forms of aerobic exercise include hiking, dancing, jogging, jumping jacks, and marching. Don’t be afraid to mix it up!

Keep in mind that the best exercise is the one you enjoy most! Be healthy and happy and always remember – age is just a number!

Leslie Sokol is the creator and founder of the adult dance and fitness program For the Young at Heart. She also teaches in retirement communities throughout Santa Barbara and Ventura Counties.

For more information contact Leslie at [email protected] 805-312-8089
or visit the website: www.LeslieSokolDance.com

Shauna McGee joins Alzheimer’s Association California Central Coast Chapter Board of Directors

Congresswoman Julia Brownley and Shauna McGee are all smiles.

The Alzheimer’s Association is proud to announce the election of longtime volunteer Shauna McGee to its board of directors for the California Central Coast Chapter.

McGee was born and raised in Ventura, where she has deep roots in a family of entrepreneurs going back to the 1940’s. As a young adult, she helped her parents run their family gourmet kitchen supply business, Toby’s Kitchen Store, a local landmark for 20 years.

She graduated college in the Bay Area and worked as a marketing and project manager for several years, returning to Ventura in 2013 after her parents passed away.

Upon her return, McGee’s dedication to serving her community led her to join a committee for the Ventura faction of the Alzheimer’s Women’s Initiative. Following this, she joined a variety of additional local committees for the Alzheimer’s Association, including The Longest Day® and Walk to End Alzheimer’s® in East and West Ventura County. In 2023, McGee is serving as co-chair of the West Ventura County Walk to End Alzheimer’s to be held on Saturday, September 23rd.

Her advocacy work for the Association expanded six years ago to volunteering with the Alzheimer’s Impact Movement as both a state and federal advocate, meeting with legislators across the country and working to introduce and pass various legislation and funding requests to fight this disease.

Most recently, Shauna met with Congresswoman Julia Brownley to advocate for increased patient access to FDA-approved Alzheimer’s treatments, which are currently being severely restricted by Centers of Medicare and Medicaid Services.

McGee’s strong desire to volunteer for the Alzheimer’s Association stems from her personal family connection to the disease.

“I have lost my grandmother and great aunt to this disease, so to say I’m invested in helping find the first survivor of Alzheimer’s disease is an understatement,” she said.

“As a board member, I hope to ensure the Alzheimer’s Association is successful in its mission to make Alzheimer’s history,” said McGee.

In Ventura County, over 9,000 people are living with the disease, expected to increase to 16,758 by 2040. It is the third leading cause of death within the county.

“Shauna has dedicated an incredible amount of time, passion and work for this cause,” said Executive Director Lindsey Leonard, Alzheimer’s Association California Central Coast Chapter. “We are grateful to have such a committed member of our Ventura community join our board and continue to make great strides towards our vision of a world without Alzheimer’s and all other dementia.”

The Alzheimer’s Association leads the way to end Alzheimer’s and all other dementia – by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Our vision is a world without Alzheimer’s and all other dementia. The California Central Coast Chapter of the Alzheimer’s Association serves San Luis Obispo, Santa Barbara and Ventura Counties. For more information, visit alz.org/CaCentralCoast or call the 24/7 Helpline at 800.272.3900.

Dottie Lindsey celebrates 100 years

Dottie has always loved Ventura.

by Ross Williams

On March 8th Dottie Lindsey will be celebrating a milestone. Her 100th birthday. Dottie moved about the living room adjusting the curtains to get the lighting just right. For a person about to turn 100 she has a lot of pep to her step and a wit to match.

“I’m one of those Dust Bowl people” Dottie said as a matter of fact. In 1936 in Oklahoma during the Dust Bowl Dottie’s father owned a soda shop. It was called the Pine Palace and it was made of half logs, equipped with a soda fountain and sandwich counter. “He made the most gorgeous banana splits that you have ever seen.” Dottie says with a grin. “And at night they would have dancing and serve 3.2 beer. It was a wonderful place.”

There deep in the heart of Baptist country many of the religious people in the area didn’t approve of the business or its “immoral atmosphere”. One late night the family received a phone call, their livelihood was on fire. Arson. With that, the family packed up all that they could fit in their car, sold off what they could, took the insurance money and moved out to California for a new beginning. The rest of their possessions were sent by rail but there was an accident on the railroad and the rest of their possessions never arrived. The trip to California was short lived as her father’s new business eventually failed and they once again returned to Oklahoma.

Just out of high school Dottie’s father passed away. With her mother at home with her younger brother and sister Dottie became the head of the household and went off to work. Dottie applied at J Paul Getty’s Spartan Aircraft just outside of Tulsa, settling for a job as a sheet metal worker and riveter when they didn’t have any open positions as secretary available. “Getty was a little guy, just about 5’5”. I had expected with all of his money and women for him to be much better looking than he was.” Dottie says with a matter of fact. One thing is clear, Dottie calls them how she sees them.

With the US now fully invested in World War II and moving operations into Africa, President Franklin D Roosevelt asked J Paul Getty to increase production and decrease rejections. With that, Dottie was one of those that Getty let go in the company shake up. Cashing in her last war bond, she gave her mother half and 20-year-old Dottie headed to Oklahoma City looking for opportunities. That’s where she met her husband George. They were married by Christmas. George was a California boy and they quickly moved out to San Francisco to start a life of their own.

Dottie and George came to Ventura in 1959. Back in those days, Ventura was a little town of well dressed people and wonderful weather. The laid back beach town vibe sat well with the Lindsey’s. They moved to the Eastside of Ventura, which at the time was unincorporated and Out in the country as she put it.”  Dottie has always loved Ventura, “It was a nice place where we could take our two boys to the drive in, watch a movie and drink cokes.” Simple things. 

George worked for the Controller’s office and Admiral at Point Mugu until his retirement. Dottie worked there as a secretary until hers. Dottie retired from Point Mugu after 22 years. “It was always exciting. I was kept busy and there was always an adventure.”

After retirement Dottie did a lot of volunteer work with Congressman Gallegly. Sitting in on quarterly breakfasts, she would often talk to him and jokingly say that both of her grandsons were in Jail. Her two grandsons are both deputies and started their careers in Ventura. Congressman Gallegly would smile and remark, “And doing a fine job of it from what I hear too!” George and Dottie did a lot of work over the years supporting the congressman.

George passed away 12 years ago and Dottie chuckles and sighs in deep remembrance as she talks about the past and present, family and friends, those that have come and gone and all of the experiences that make a life worth living. She had even had an autobiography that she was working on but it was lost at some point.

After our interview Dottie took me on a tour of her prized garden, showing off her collection of large and healthy orchids just ready to bloom. We picked oranges off of her tree with daughter Sandy. We looked over her collection of teapots and talked about the little details of life that give her joy. Painting, crafting, reading and all the things that make a life worth living.

Editor: If you are a senior (over 70-years), or know of one, who would like to share their retirement, or job, with us please let us know at [email protected].

Ventura County Parkinson’s support group meetings

A community-based support group focusing on sharing relevant information and education about all things Parkinson’s.

Meetings are held monthly on the third Tuesday, 10-11am, AT Crosspointe Church (5415 Ralston Ave.) Next meeting: Tuesday, March 21, 2023.

Ventura County Parkinson’s Support Group gets together every month with skilled, experienced professionals who present significant breakthroughs, strategies and related issues surrounding Parkinson’s. The group’s mission is for participants to better understand and talk about how this information impacts their own lives and affects immediate family members. In addition to those diagnosed with PD, caregivers, family members and friends are all welcome to attend free of charge.

More than just a meeting, all discussions/presentations offer interactive, compassionate, relevant education on PD. Topics range from “How to get up off the floor when you’ve fallen,” to “Nutrition and Parkinson’s” to “The benefits of deep brain stimulation and assessing if you’re a good candidate for DBS.”

Jon Everhart, retired accountant, US Marine and regular group attendee said, “It’s nice comparing treatments, symptoms, and the challenges we all face living with Parkinson’s.” This caring group empowers people like Jon to be more proactive and to participate in deciding the direction of his treatment, complemented by his team of doctors’ suggestions.

This unique group gives everyone a great opportunity to learn more about current PD research, to gain more awareness about local help and resources, to share relevant experiences with others — and to have fun along the way.

The Ventura County Parkinson’s Support Group was recently resurrected (post-Covid) by Dr. Vanessa White, owner of Ventura County Neurofitness (a local fitness program designed specifically for those with Parkinson’s and other neurological degenerative diseases). The impetus for her assuming this responsibility was after her mother-in-law, Toy White, was diagnosed several years ago with PD. This important, special group was born upon her passing.

“The Young at Heart”

by Leslie Sokol
I always say to my students, “Age is just a number.” Don’t let your age hold you back! As you age, it is essential to keep your body moving and active through regular exercise. Physical activity is the cornerstone of healthy aging – it will keep you in shape, improve alertness, and increase energy. Scientific evidence suggests that people who exercise regularly not only live longer, but also live higher-quality lives with less pain and chances of disability.

A good fitness routine includes three components: stretching, strengthening and aerobics.

Stretching: The three L’s — longer, looser and limber — are what you want your muscles to be. Stretching increases your range of motion and reduces your chance of injury. You become more flexible, which allows you to move faster, easier and more freely. It also enhances good posture and body placement.

Strengthening: Strength training is crucial for building muscle mass and firms your body. Building muscles helps support your joints and prevents injury. It is also better to have more muscle than fat because muscle burns more calories, even when you’re not exercising.

Aerobics: It’s critical to care for the most important muscle in your body – your heart! Any kind of exercise that that gets your heart rate pumping (i.e., walking, dancing, swimming) is an absolute must for any fitness routine. Cardio helps strengthen your heart and lungs and increases the amount of oxygen in the blood. Aerobic exercise also burns calories, releases endorphins and gets you in great shape!

In my next article, I will provide examples of exercises for each of these components so you can achieve balanced fitness. Remember, the best exercise is always the one you enjoy the most! Our bodies were made to move – sound body, sound mind!

About the Author

Leslie Sokol is the creator and founder of the adult dance and fitness program For the Young at Heart. She has been teaching adults and children for forty-five years. You can watch For the Young at Heart by visiting her YouTube Channel or on TVSB. She also teaches in retirement communities throughout Santa Barbara and Ventura Counties.

For more information contact Leslie at [email protected] 805-312-8089
or visit the website: www.LeslieSokolDance.com

Kindness and compassion towards seniors on Valentine’s Day

by Carol Leish, MA

“We at Assisted Home Care & Hospice,” according to Natalie Uribe, who is the Home Care Specialist at Assisted Home Care & Hospice, “were happy to be participating our first year in handing out Valentines to seniors living at various senior living communities. Pre-Kindergarten through 5th Graders participated in coloring Valentine Day cards during Kindness Week, which was the last week of January, 2023. The elementary schools in Ventura that participated were: Will Rogers, Montalvo, Portola, and Loma Vista.

Some seniors were moved to tears of joy.

“Some seniors were moved to tears of joy, after seeing the cards. They reminisced about when their children were going to elementary school. The cards said things, such as: ‘You are wonderful.’; ‘You are so special’; and, ‘Remember that you are loved today.’”

As Principal Perez, of Will Rogers Elementary School said, “It was a coincidence that making Valentines for seniors did occur during Kindness Week of January 23, 2023-January 27, 2023. And, we become kind and caring by doing kind and caring things each day, not just during one week.”

“These Valentines from students,” according to Uribe, “shine some light on the kids, and how they are impacting the lives of seniors. We want to thank all of the schools for helping out to share love on Valentines Day throughout the community, since this is about both seniors receiving love and about the children expressing love towards them. We will be giving to the various schools videos of the senior receiving the Valentines in order for the children to see the impact that they had had upon them.”

Let’s continue to spread love and joy to others throughout the year.

Gut microbes may affect motivation to exercise

From NIH Research Matters

Exercise provides many health benefits, including protection from many diseases. Some people seem to enjoy physical activity more than others. But the mechanisms affecting people’s motivation to exercise are not well understood.

Researcher swabbing a petri dish with bacteria to study the microbiome of mice.

An NIH-funded team of researchers, led by Dr. Christoph Thaiss at the University of Pennsylvania, set out to identify factors affecting exercise performance in mice. Their study appeared in Nature on Dec. 14, 2022.

The researchers first measured how long mice running on a treadmill took to exhaust themselves and how much the mice voluntarily ran on a wheel. They found that the makeup of the gut microbiome — the trillions of microbes living in the gut — predicted these values better than genetic, metabolic, or behavioral traits. When the researchers used antibiotics to eliminate gut microbes, the mice got exhausted earlier and ran less on the wheel.

Motivation is controlled in part by a region of the brain known as the striatum. Neurons in the striatum are activated by the neurotransmitter dopamine. Dopamine activation provides a feeling of reward. The team found that dopamine levels in the striatum increased after exercise in normal mice, but not in microbiome-depleted mice. Treating mice with a drug that blocks dopamine signaling had the same effect on exercise as depleting the microbiome. Conversely, a drug that activates dopamine signaling restored exercise capacity in microbiome-depleted mice.

Activating certain sensory neurons in the gut restored exercise capacity in the microbiome-depleted mice. But when dopamine signaling was blocked, so was the effect of these neurons. The researchers then tested mice engineered to lack these same sensory neurons. They found that the mice had impaired exercise capacity like that of microbiome-depleted mice.

Next, the team screened various compounds produced by gut microbes to see which ones could stimulate gut sensory neurons. They identified a class of compounds called fatty acid amides (FAAs). Supplementing the diets of microbiome-depleted mice with FAAs restored their exercise capacity.

Several FAAs are known to activate a receptor on sensory neurons called cannabinoid receptor 1 (CB1). The team found that blocking CB1 had the same effect on exercise as microbiome depletion. When CB1 was blocked, dietary FAA supplementation did not restore exercise capacity. But activation of dopamine receptors still restored exercise capacity even when CB1 was blocked.

These results suggest that microbiome-produced FAAs in the gut stimulate sensory neurons. Signals from these sensory neurons lead to increased dopamine levels in the striatum during exercise. Dopamine, in turn, enhances the desire for exercise. The findings suggest that the motivation to exercise — or lack thereof — might depend on the state of the gut microbiome. The motivation for exercise, then, might be enhanced by stimulating this sensory pathway.

“If we can confirm the presence of a similar pathway in humans, it could offer an effective way to boost people’s levels of exercise to improve public health generally,” Thaiss says.

by Brian Doctrow, Ph.D.

This research was supported in part by NIA grant DP2AG067492.

Studying the retina’s close connections to the brain for clues about cognitive health and the risk of brain disease.

In recent years, Koronyo-Hamaoui, Ph.D., M.S. (a professor in the Cedars-Sinai Department of Neurosurgery) and her colleagues have discovered the first evidence of the specific diagnostic signs of Alzheimer’s disease-related amyloid beta protein plaques in retinas from Alzheimer’s and mild cognitive impairment patients. In a series of several NIA-funded innovative studies, her team found increased retinal amyloid plaques and associated retina blood vessel and nerve cell degeneration in patients compared to age and sex-matched cognitively healthy individuals.

Her team also created a low-cost, noninvasive technique to detect Alzheimer’s protein plaques at a very high resolution in the retinas of living patients. Additionally, they developed a modified version of a powerful eye imaging tool — the scanning laser ophthalmoscope — that includes a wider look at previously overlooked peripheral regions in the retina. They combine this scan with giving research participants an oral dose of curcumin, a natural compound that lends zest and orange color to Indian spices such as curry and turmeric. Curcumin is naturally drawn to amyloid beta, the protein that comprises Alzheimer’s disease plaques in the brain, making it easier for the researchers to spot.

“You can look at the retina and see things at the molecular, cellular, and vascular levels, like protein aggregates and vascular abnormalities,” said Koronyo-Hamaoui. Her team is exploring if optical retinal imaging with curcumin could be a cost-effective test to identify Alzheimer’s pathology, including in people with mild cognitive impairment. “We uncovered parallels between the effects of Alzheimer’s disease in the retina and brain, and that specific changes in the retinal regions mimic changes in the brain and cognitive status,” she added.

Koronyo-Hamaoui’s team is collaborating with neuropathology experts across the United States, Europe, and Australia to expand their studies into Alzheimer’s retinopathy and visual deficits to see if a similar test can detect buildup of the protein tau, another hallmark of the disease, in the retina. Their hope is to develop affordable, accessible retina-based scanning technology that might someday be used in combination with routine cognitive and brain imaging for the earlier detection of Alzheimer’s and related dementias, Parkinson’s disease, and stroke.

Untreated vision loss can be especially devastating. Using data from the Health and Retirement Study, NIA-funded scientists recently made the case for including vision impairment as a risk factor for dementia, estimating that nearly 100,000 dementia cases in the U.S. could possibly have been prevented with existing vision treatments.

Older adults stop driving, they stop going out, they have difficulty reading, and they don’t exercise as much because they’re afraid of falling. Untreated vision problems really reduce social interaction, emotional well-being, and physical activity, which are all risk factors for cognitive decline.

Which vaccines do older adults need?

“Do I get a lollipop after?”

As you get older, a health care provider may recommend vaccinations, also known as shots or immunizations, to help prevent certain illnesses.

Talk with a doctor or pharmacist about which of the following vaccines you need. Make sure to protect yourself as much as possible by keeping your vaccinations up to date.

Flu — short for influenza — is a virus that can cause fever, chills, sore throat, stuffy nose, headache, and muscle aches. Flu is very serious when it gets in your lungs. Older adults are at a higher risk for developing serious complications from the flu, such as pneumonia.

The flu is easy to pass from person to person. The virus also changes over time, which means you can get it again. To ensure flu vaccines remain effective, the vaccine is updated every year.

Everyone age 6 months and older should get an annual flu vaccine, but the protection from a flu vaccine can lessen with time, especially in older adults. Still, you are less likely to become seriously ill or hospitalized with the flu if you get the vaccine. A flu vaccine is especially important if you have a chronic health condition such as heart disease or diabetes.

There are flu vaccines designed specifically for older adults. The CDC recommends that people age 65 and older receive a higher-dose flu vaccine or an adjuvanted flu vaccine (one with an additional ingredient called an adjuvant that helps create a stronger immune response). These vaccines are potentially more effective than the standard flu vaccine for people in this age group. Talk with a health care provider or pharmacist about which vaccine is best for you.

Pneumococcal disease is a serious infection that spreads from person to person by air. It often causes pneumonia in the lungs and it can affect other parts of the body. Older adults are at higher risk than younger people of getting very sick or dying from pneumococcal disease.

The CDC recommends that all adults age 65 and older get pneumococcal vaccination. This vaccine will help protect you from getting a serious infection, including pneumonia. There are multiple forms of the pneumococcal vaccine: Talk to a health care provider to find out which is best for you. You can also visit the CDC’s Pneumococcal Vaccination webpage to learn more about the types of vaccines that are available.

Tetanus (sometimes called lockjaw) is caused by bacteria found in soil, dust, and manure. It can enter the body through a deep cut or burn.

Diphtheria is a serious illness that can affect the tonsils, throat, nose, or skin. It can spread from person to person.

Pertussis, also known as whooping cough, causes uncontrollable, violent coughing fits that make it hard to breathe. It can spread from person to person.

Getting vaccinated is the best way to prevent tetanus, diphtheria, and pertussis. Most people get vaccinated as children, but you also need booster shots as you get older to stay protected against these diseases. The CDC recommends that adults get a Tdap (tetanus, diphtheria, and pertussis) or Td (tetanus, diphtheria) booster shot every 10 years. Ask a health care provider when you need your booster shot.

Shingles is caused by the same virus as chickenpox. If you had chickenpox, the virus is still in your body. As you get older, the virus could become active again and cause shingles.

The shingles vaccine is safe, and it may keep you from getting shingles and PHN. Healthy adults age 50 and older should get vaccinated with the shingles vaccine, Shingrix, which is given in two doses. (Zostavax, an earlier shingles vaccine, is no longer available in the United States.)

Before getting any vaccine, talk with a doctor or pharmacist about your health history, including past illnesses and treatments, as well as any allergies. A health care provider can address any concerns you have.

It’s a good idea to keep your own vaccination record, listing the types and dates of your shots, along with any side effects or problems.