Pharmaceutical companies quickly realized just how enormous the market for “Cholesterol Lowering Drugs” truly is. They realized they could quite effectively get you to take a drug for years and years, and which, wasn’t toxic enough to kill you quickly.

These drugs that are suppose to lower cholesterol (statins) generate profits in the tens of billions of dollars every year for big pharma.

To do this they leveraged their marketing efforts to select “experts” in the medical community and got them appointed to government panels making recommendations that were adopted by almost everyone in the medical and health community.

The most recent panel for the US Cholesterol Education Program eight of the nine doctors had clear ties to drug companies. Specifically to the companies making “cholesterol lowering drugs. And the result? You guessed it, revised guidelines that advise people at risk of developing heart disease to lower LDL cholesterol (bad) to extremely low levels.

Up until 2004 having a LDL level of 130 was in the “healthy” range. The new and “improved” guidelines now put the upper limit at 100 for regular patients and 70 for those considered to be at a high risk or heart disease.

To be able to reach and maintain these dangerous and outrageously low targets a patient would need to consume multiple drugs aimed to lower cholesterol. So, the new guidelines artificially boosted the market for these drugs.

Your health is in your hands, and I want you to have the full picture. I hope you understand that most of what you hear from conventional medical practitioners is little more than cleverly disguised marketing.

I am very concerned about the new drugs the drug companies are producing to treat various diseases and conditions. One especially has impacted my life and my wife’s to the extent that we had the most disastrous ten months of our lives. I am presently 72 and my wife is 68 and we were very active and spent as much time as we could watching our five grandchildren. If that does not keep you in pretty good shape then nothing else will.

My wife has a condition known as gastroparesis which is the abnormal emptying of the stomach into the digestive tract. The stomach empties very slowly and causes discomfort to the person. It can be very disconcerting. We went to a gastroentrologist and he prescribed a drug called metroclopromide. The name metoclopromide is the generic term for Reglan, made by various manufacturers. She took this drug at every meal from April up to December. It seemed to work well for the first few months.

By June she started having the most severe feelings of nervousness and insomnia. Jerking movements of the legs and feet and the inability to sit still. Jaw clenching and mouth twisting and chewing motions. The symptoms seem to mimic parkinsonism to a degree with facial grimacing and lassitude, and mainly described by a disorder called tardive dyskinesia with hand tremors and involuntary movements of the trunk and extremities and the mouth and face. The person develops the inability to sit still and deep depression develops and suicidal feelings can develop.

I can remember feeling as if I were going to lose her to a possible physical and or mental breakdown. We were frantic going from one doctor to another for help in finding out what was happening and why? The doctors tried many different medications and none made a big enough difference to help in any real way. We went to see a psychiatrist and an internist and a parkinson specialist and several other specialists trying to find the cause of all these symptoms.

By the time things became really bad, she lost her appetite altogether and ate very little and stopped taking the metoclopramide in December. Things started to improve slightly and we started to look on the web for things we could try. At the time we did not connect the medication to the problems. We eventually found that the drug had been investigated because of the great many people that were reporting adverse symptoms and reactions and that the FDA had issued a black box warning to be placed on metoclopramide . When we did look up the drug we found that their were many lawsuits going forward and even class action suits. The other problem was that doctors were not advised about strictly limiting the use of the drug for periods of not more than six weeks. This warning came in late February of 09.

After several months the symptoms she had, started to ease up but very slowly. The return of feeling and the loss of the abnormal movements took a period of several months. Thank God they gradually disappeared after the awful time we spent dealing with them and trying to stop them by using every means we knew of. It was a very stressful time in our lives. We had literally gone through hell.

I have looked up the effects of this medication and in a large number of cases the symptoms are irreversible. Their are so many problems associated with this medication that I am very surprised that the FDA has allowed its use. It was not until February that they mandated a black box warning for the drug. And that only after the emergence of the cases effecting all those people and the seriousness of the symptoms.

Our case is one of many that have been effected by the use of this drug. I can only imagine how many other drugs their are that have not been completely tested and their contraindications and side effects thoroughly tested. It seems as if the drug companies are trying to get these drugs to the market so fast, they lose sight of the very real possibilities of danger to the patient.

I am sure that their are many people who would be willing to take any medications if they could only relieve the symptoms that they have. People will try anything to treat what they are going through and especially to stop pain at any cost. That does not mean that dangerous drugs should be made available to a marketplace without the most thorough and complete testing possible.

Their are places where drug trials are made involving people who will accept any risk to relieve their symptoms or diminish their pain or for any number of problems they have. This does not give the drug companies the right to put drugs into the marketplace without rigorous testing as to length of use, dosages, and every conceivable problem that could arise.

No drug is without some risk but it is their duty to make that risk as small as is humanly possible for each and every drug they place into the marketplace. The FDA should be more than just a rubber stamp for the information the drug companies supply from their own investigations and tests. Independent testing must be stressed for every new drug submitted from drug companies to the FDA and be backed up by universities equipped to do the testing.

Their would be a great many problems to be worked out to set up a program like that but it must not be run by the government. They have an abysmal record in running any program for the benefit of the people without getting all the special interests involved. It seems that today in Washington, it is the largest pig trough for all the special interests to line up and get their cut out of every program set up. Senators and congresspeople also line up for their contributors to get special treatment and make money.

The problem remains for us to receive the best and safest and most tested drugs for human consumption to treat specific problems that humans can devise. Drugs with side effects that can be more dangerous than the conditions they are to treat must be eliminated and not put on the market just so drug companies can recoup the money they spent on research if the drug does not pan out as safe.

The FDA had been set up to test and approve or disapprove drugs based on information provided but we must insist that they provide rigorous testing on their own and not accept drug trial information as gospel from drug companies.It is a very complicated system we have now but it must be made more open and able to be checked and rechecked. Doctors can only use drugs safely if they are given complete and honest and up to date information about the drugs they prescribe for their patients with all the side effects honestly given them from the FDA and not supplied by drug companies alone. Drug companies send their representatives around to doctors offices to ply them with trips, free vacations, dinners, and many other types of gifts to influence the way they prescribe and use their products over others. This graft has to stop. Drug companies must not be allowed to give any inducements to doctors or hospitals for them to use one drug over another for any reason other than it is a superior product.

Drug companies could hold seminars and invite all doctors and give them all dinner while explaining the new drugs and their uses and their testing and safety. Their is nothing wrong with that approach as it gives the doctor what they need to know and the drug company the audience to prove their drugs efficacy. If we as a nation of consumers do not take the time to look into what is going on around us and try and take steps to do what we can to improve things for ourselves and our children then we will deserve what we get. The drugs we use for ourselves and our children make it our responsibility to assure their safety. Ask the doctors if the drugs they are prescribing are free from side effects harmful to us. Do not be afraid to speak up! If you do not , then who will.

It is up to you America to make the time for problems that effect us all and make changes in the laws and rules and regulations that allow unfair practices to continue. Remember! ” All that is needed for evil to triumph is for good men to do nothing ” Wake up people!

Foreign bodies are frequently aspired into the pharynx, the larynx or the trachea, especially in children. They cause symptoms in two ways; by obstructing the air passages they cause difficulty in breathing that may lead to asphysia; they may be drawn further down later on, entering the bronchi or one of their branches causing symptoms of irritation, such as a croupy cough, bloody or mucous expectoration and paroxysms of dyspnea. If the foreign body has been lodged in the pharynx, it may be dislodged by inserting the finger. If the obstruction is in the larynx or the trachea, a tracheotomy is immediately necessary.

A tracheotomy is an operation in which an opening is made into the trachea through which the patient may breathe. It may be performed for any one of several reasons: an inadequate upper airway, which may be caused by tumors, foreign bodies, edema, nerve or vocal paralysis; a need for effective removal of excessive tracheobronchial secretions; shallow respirations resulting from unconsciousness or respiratory paresis; problems resulting from poor gas transport across alveolar capillary membrane as may occur in severe pulmonary edema or prolonged cardiac or lung surgery; and the need to reduce dead space when tidal volume is impaired as in severe emphysema. If the opening is permanent, then it is called a tracheostomy.

For the surgical procedure the patient is placed in supine position with the head in midline and the neck extended with the chin pointing to the ceiling. Local or general anesthesia may be infiltrated. A bronchoscope or endotracheal tube may be in place fro oxygen and anesthesia. A vertical or horizontal incision of approximately three centimeters is made about two centimeters above the suprasternal notch. The sternohyoid and sternothyroid muscles are separated midline. The front part along the trachea is dissected to allow insertion of small curved retractors that help to immobilize the trachea. A vertical incision is usually made through the second and third tracheal cartilages. Forceps or a tracheal dilator is used to spread the incision and the proper tube with obturator is slipped into the trachea, this is held in place by tapes which are fastened around the patient’s neck. A square piece of sterile gauze is placed between the tube and the patient’s skin before the tape is fastened.

The tubes are usually made of sterling silver, although plastic is available. Each tube consists of three pieces: an outer cannula, to which the retaining tapes are fastened; an obturator, an olive shaped, curved silver rod used to guide the cannula into the opening in the trachea; and an inner cannula, which is inserted into the outer cannula after the obturator is withdrawn. The standard procedure for fitting of the tube is as follows: the outer tube plate is flush with the skin of the neck, without any pressure; aspirating catheter can easily pass through the tube; and the patient can breathe easily through the tube.

When emergencies arise in which a tracheotomy must be done, the life of the patient is at risk, and strict observance of aseptic technique and the psychological preparation of the patient is important. However, there are instances where there is time to explain the purpose of the surgery to the patient, with the result that he will adjust much better to his situation. He should realize that he will lose his voice temporarily, and will breathe through a tube in his trachea.

The patient with a tracheotomy needs to be humidified, since the nose and the pharynx usually moisten the inspired air and filter out the dust; this is no longer possible for the patient. Therefore, it is necessary to have continuous moist air for the first two to three days. After the operation many surgeons usually cover the opening of the tube with a few layers of gauze moistened in warm saline solution. This tends to moisten the inspired air and filter out the dust. Heavily saturated mist can be provided in a tent, by ultrasonic fog, or inhalation of nebulized water, saline or mucolytic agents. An adequate intake of fluids also helps in the humidification process.

Fluids may be given to the patient during the day of the operation. Careful attention is given to the mouth before and after meals and whenever necessary. The patient may be placed in a sitting position. Paper and pencil or a marker should be kept near the patient as a means of communication. A tap bell or electric cord signal should be within the patient’s reach, as he needs reassurance, especially during the first night, as he may fear that he will suffocate.

Blood-tinged mucous is usually the first signs of secretion to come through the tracheotomy tube. As time goes by, the amount of blood that passes through should diminish and disappear. All secretions should be carefully and quickly wiped away before they are aspirated by the patient. The secretions are aspirated by a sterile rubber or polyethylene catheter connected to a suction machine. The catheter should be cut diagonally at the tip and have two or three holes along the side. To avoid irritation of the lining of the trachea, the suction is turned off while the catheter is inserted.

The suction is adjusted to the type of secretion to be removed. Suction should be applied intermittently for periods no longer than five seconds. Prolonged aspiration may produce a drop in the arterial oxygen concentration. Insufficient suctioning irritates the mucosa of the trachea. It is recommended that sterile gloves be worn by the individual performing the suctioning to prevent contamination of the suction tube. The tube can be exchanged for a sterile tube with each suctioning.

Ohaus precision weighing balances offer accurate solutions for pharmaceutical research, general lab use, drug discovery and university research. Balances manufactured by Ohaus, a New Jersey based company, are designed to meet current requirements and also to suit future needs. One can choose from weighing balances of different operating temperatures, capacity, readability, repeatability, stabilization times and linearity.

A Variety of Application Modes and Features

The glass and steel structure resists static effects and offers great protection against corrosion. Superior AutoCal element automatically regulates the system whenever a change occurs in temperature. The RS232 interface with GLP data output links to a printer or PC and records GLP/GMP data such as date, balance ID, project ID, time, reference data and user ID. Different application modes like density determination, dynamic weighing, totalization, parts counting, pipette calibration, per cent weighing, and check weighing are found in Ohaus precision weighing balances.

Other features of these weighing balances include:

1) User-selectable filter settings that make up for disturbances such as vibrations

2) Environmental settings

3) Up front level indicator that makes certain that the balance is level

4) Menus for software reset and lockout

5) Communication settings, printing selections, data print selections and span calibration points that are user choosable

6) Stability indicator

7) AC adapter

A number of weighing units

9) In-use cover

10) Auto tare

Cut Costs by Purchasing Reconditioned Balances

There are numerous reputable providers of old, used, reconditioned and brand new Ohaus precision weighing balances. Reconditioned balances are a wonderful option to consider for laboratories and medical establishments that cannot afford new pieces. Any problems in the used equipment would be fixed and the apparatus cleaned before it is sold as reconditioned equipment.

Are you one of those who regularly fail to take medicines on time? Or if you have parents who are old and need help in reminding them of the medication every now and then?

The best solution to both these is the automatic pill dispensers. These pill dispensers have an in built vibration mechanism or an in-built alarm clock to remind you. These dispensers are a new thing that has hit the market. In the earlier times this was not case and most of the times people used to have their alarm clocks set up to help them remember the timings for the medicines.

The basic pill dispensers like those that are there at the back of the birth control pills have the days of the month printed. This helps to know how many of those pills have you taken. However these are not reminders but mere dispensers.

The automatic pill dispensers in the market nowadays are more of reminders which have alarm clock. You can set up that alarm clock to give out an alarm for up to 28 times in a day. In fact these have the LED lights which can also light up for people who have hearing problems.

Another major feature of these dispensers is the pill box that is provided. In this pill box you have separate compartments and you can separately keep 28 different types of pills in the dispenser. This helps in taking the right medicine at the right time. This is very much needed when you have parents who are old and have major memory issues.

The only challenge with these pill dispensers is that these need a little bit tinkering before you can become an expert at using it. That can be a tough thing for the elderly folks to do. It is small price to pay though for all the remembering troubles that you have.

Osteoarthritis is the most common form of arthritis affecting over 30 million people. This occurs when the cartilage in our joint breaks down. Without this cartilage the bones rub together resulting in pain and decreased mobility. The amount of pain will vary with each individual. Some people that have an advanced case of the disease will experience little to no pain while others that have a more mild case experience severe pain.

Any treatment plan must be tailored to the individual. A plan that works well for one person will not necessarily work well for another, even if the same joint is affected. The purpose of any treatment plan is threefold: first to relieve pain, secondly to increase the mobility of the joint and lastly to minimize any further joint damage.

Weight is one of the risk factors for osteoarthritis. If you are overweight this puts added stress on weight bearing joints such as hips and knees. If you are overweight at an early age this will increase your chance of contracting the disease later in life. It has been shown that if you have osteoarthritis even a small reduction in weight can significantly reduce the pain associated with it.

Exercise can increase the mobility of the joint and strengthen the muscle around it preventing further damage. This is why your doctor may want you on a regular exercise program. Water exercise has been used successfully in people with arthritis of the hip or knee. These people also should avoid activities such as running or jogging that will put added pressure on those joints. Treatment usually involves a combination of stretching, isometric and aerobic exercises, each provides a different benefit. You should always consult with your doctor before starting any exercise program.

Although only a temporary solution, treatment with hot or cold packs can relieve pain, swelling and stiffness. Some cases will benefit more from heat treatments while other respond better to cold. It is dependant on the individual situation.

There is a wide variety of pain medications available. Some are sold over the counter while others will require a prescription from your doctor. People that experience unexpected severe pain will be better served by these medications, while for people with chronic pains other treatments may be in order. You need to remember that there are side affects to all medications. Some patients have reported positive results with a combination of glucosamine and chondroitin which is a more natural remedy. This has been shown to assist in the rebuilding of cartilage over time.

Stress can amplify the symptoms of osteoarthritis. Prolonged stress depletes our bodies of needed vitamins and nutrients. There are a number of things we can do to relieve the stress of everyday life. Try techniques such as yoga, meditation or deep breathing exercises and see what works best for you.

Remember that treatment of this disease is a matter of trial and error to see what works best in your particular situation. Explore these treatment methods with the advice of your doctor. In some cases where none of these treatments are successful he or she may suggest injections or surgery.

Ohaus Adventurer Pro balances have earned the reputation of being the most flexible balances in the industry. The Ohaus balance can be used for chemical and laboratory applications, for simple operations in inventory applications, and for environmental testing. It holds, sums and counts and its results are appreciable. It supports a variety of weighing units including gram, milligram, kilogram, pennyweight, Taiwan tael, Hong Kong tael, ounce, baht, carat, tola and Newton.

Flexible Settings and Options

The design of the balance suits these types of weighing - basic, dynamic/animal, check, below-balance and percent. The totalization mode enables you to find the total for a set of sample weights. You can choose your preferred environmental setting. Modifiable zero tracking and three filter modes make it easier to work in slow filling applications where sensitivity is essential. In difficult environments, a user can change balance settings to make up for disturbances such as vibrations.

Given below are some of the other features of Ohaus Adventurer Pro balances:

1) Huge weighing platform made of stainless steel

2) Stability indicator

3) Choosable printing options

4) Menus for software reset and lockout

5) Selectable options for data print

6) Integrated security bracket

7) Auto tare

Communication settings that can be chosen by the user

9) Clear display and user-friendly keypad

Reconditioned Balances Are Ideal for Small Budgets

Medical establishments, individual practices and doctors that cannot afford new machines can always opt for reconditioned Ohaus Adventurer Pro Balances, the quality of which is comparable to that of a new system. Check out referrals or go online to find a suitable, reliable provider of reconditioned analytical balances from Ohaus or from other brands.

If you follow my articles, you may have seen my previous writing called Chronic Pain - Alternatives to Narcotic Medications, that talks about the success of psychotropic drugs to relieve chronic pain. In that article, I explain that a pain nerve impulse, is really just like any other nerve impulse, for instance, sound, smell, heat, or pressure. It’s not until the impulse reaches your brain, is processed and becomes a “thought”, that it really manifests itself as pain. In other words, it’s like an electrical current traveling up a wire and is heading towards a random switch that automatically switches the power between a red light bulb and a green light bulb.

Until the current hits the switch, and is diverted to one bulb or the other, it’s just a current. The current doesn’t care where it’s going, and it doesn’t know whether it’s going to make the red or the green light bulb shine. In the same way, the nerve impulse is just an impulse. Until your brain finally sorts it out, and you have the thought of pain, it’s not pain! Are you with me In the same way, placebo medications are thought to have a similar effect on pain control. Every ER physician that has been around for a while knows that people with minor ailments can often receive a shot of old plain salt water, (of course you don’t tell the patient its saline), and they’ll later report significant improvement or even miraculous recovery.

Placebo medications have been used in clinical trials since clinical trial and the scientific method began. Recently however, a German team of researchers tested “what they said” was a pain relieving lidocaine cream, along with a placebo cream. Basically, they told the patients they were going to burn their forearms and then test the effectiveness of the two creams. What they really did, was create a placebo cream, and then a fake lidocaine cream, and make the patients believe that the “fake lidocaine cream” was working. They did this by turning down the heat level at the fake lidocaine test site. At the same time they maximized the heat level of the “placebo cream” test site, so the patients felt more pain with the known placebo.

Then, after the patients were convinced that the “fake lidocaine cream” was genuine medicine, they were hooked up to MRI to look at brain activity during a new burning session with the two creams! In each case the fake lidocaine cream had a much more profound effect of pain relief when compared to the placebo, as exhibited by both patient response, and by MRI imaging of brain activity. It is thought that endorphins, the brain’s natural opiate (as they call it), blocks the neural pathway that manifests pain in the brain. I’m still waiting for them to come up with an endorphin pill for me to take when I go to the gym.

Have you ever worked out so hard that immediately after you felt clobbered, barely able to move a muscle? Or worked out so intensely that you were incredibly sore the next day, and limped around feeling tired and unwilling to do your next workout? If so, then you probably would have benefited from a recovery drink, which would have injected an optimum amount of nutrients into your system so as to help your body bounce back from all that strenuous effort. But why? What is a recovery drink, and why is it so helpful after an intense workout?

The key concept behind recovery drinks is the ratio of carbs to protein that was formulated by John Ivy and Robert Portman in a seminal study available for closer examination in the book Nutrient Timing: The Future of Sports Nutrition. They discovered that if you ingest the correct amount and ratio of these two nutrients your body will absorb them at maximum efficacy during a thirty minute window immediately after your workout, allowing for faster recovery as depleted reserves are replenished.

What reserves? Think blood sugar. When you begin to exercise hard, say with High Intensity Interval Training or a workout program like INSANITY, your body immediately begins to burn through your blood sugar in a process called glycogenesis. There’s a limited amount of this high energy starch in your blood, however, so your body will then turn to other sources of energy. Depending on the intensity of your workout that could be fat if you’re doing aerobics, or by breaking down your body tissue if you’re pushing yourself so hard you’re functioning anaerobically. Either way, the result is the same: no more glycogen in your system, and shredded muscles.

It is precisely then, during that key thirty minute window after your workout that a mega dose of recovery drink could be so beneficial. The ratio of 4:1 carbs is vitally important, since if you take in more fat or protein you could slow down your body’s absorption rate. The high amount of carbs rushes in to restore your blood sugar levels, while the small dose of protein helps said absorption rate and goes to your shredded muscles so as to help them begin reconstituting themselves. Thus your reserves are immediately restored, the healing and growing process kick started, with the result that you won’t feel so massacred after your workout, and will instead be ready for your next one with a grin on your face.

Does every workout need a recovery drink after? Not necessarily. A recovery drink is excellent if you’ve depleted your blood sugar levels. If you worked out aerobically, going for a slow jog say or not pushing yourself beyond your comfort levels, than you probably only need half a cup of recovery drink, if at all.

Another factor to consider is how much blood sugar you began your workout with. If you’re a naturally lean person who eats a lean diet, than you may be operating on low sugar levels already, and a sip or two of recovery drink during your workout could be of great benefit. On the other hand if you have tons of blood sugar or feel fine right after your workout, than you probably don’t need to drink a recovery drink at all.

So why should you drink the recovery drink? Because it will inject key nutrients you’ve depleted into your system, helping you recover faster and feel better sooner so as to maximize your results and get ready for your next workout. Simple!

Bronchitis has several different treatment options but one thing that all patients must remember is that if the bronchitis steams from a viral infection, antibiotics will not cure the problem. In the majority of cases, bronchitis is a short-term condition that does not require any treatment besides medications to relieve the discomfort due to the symptoms.

For at home care without visiting a physician the best medications to use will help with fever and pain. The medications that will help with fever and pain include Acetaminophen like Feverall, Panadol, & Tylenol, aspirin, or ibuprofen such as Motrin, Nuprin, and Advil. For the cough, the over counter cough suppressants that are most commonly used include Robitussin, Breonesin, Mucinex, Benylin, Pertussin, Trocal, and Vicks 44.

With any illness where mucus is involved, it is always recommended that the patient drink plenty of fluids. The main reason this is true is that fever will cause the body to lose liquid quickly and the mucus will be easier to expel. Some individuals use a cool mist humidifier or vaporizer that will help with the irritation of the airways.

Rest and staying away from inhaled irritants is always a great way to aid in relieving some of the symptoms. If you smoke or in the house with a smoker, it is best to stay away from smoke as it can irritate the airways and cause more coughing.

Even if you wish to treat your bronchitis at home, you should visit your physician to ensure that you do not have a bacterial infection that brought on the bronchitis. Bacterial infections will need antibiotics in order to recover in the majority of cases.

Talking with your physician you may be prescribed different treatments or he/she may recommend different treatment according to the cause of bronchitis. Coughing is the number one symptom of bronchitis and is the symptom that in most cases will need some type of medication to control whether over the counter or prescription. For individuals that have severe coughing spells, your physician may prescribe a stronger cough suppressant. To aid in opening airways and decrease wheezing, bronchodilator inhalers are often prescribed.

For individuals with severe cases of chronic bronchitis physicians often prescribe oral or inhaled steroids. This will help reduce inflammation.

Remember if you have chronic bronchitis, you should not treat this on your. Individuals with this type of bronchitis are prone to infections and will need the expertise of a doctor to prescribe the correct medications and treatment. Do not take over the counter medications until you have spoken with your doctor. Your physician may prescribe a round of antibiotics that will aid in fighting any type of bacteria you may have and will also recommend that you quit smoking if you smoke. If you are overweight, the doctor will more than likely recommend a diet so as to lose weight so you do not add more strain on your heart. Patients with chronic bronchitis are normally prescribed with an anticholinergic bronchodilator, which aids in dilating the airways so the patient can breathe easier. In severe cases, the doctor often prescribes oxygen therapy, as the individual may not be able to transfer enough oxygen into the bloodstream.

Prevention

There may not be an exact way to prevent bronchitis as the majority of the times it develops after a viral infection. On the other hand, studies have shown that individuals that smoke, children around second hand smoke, and those that are repeatedly around air pollutants often develop more cases of bronchitis.