Review Category : Health

The UN’s Role in the Devastating Cholera Epidemic in Haiti

iStock/Thinkstock(NEW YORK) — As Hurricane Matthew churned off the coast of Haiti earlier this month public health officials and aid groups issued warnings not just about the dangers from the storm itself but what could follow: a cholera outbreak.

In 2010, a devastating cholera outbreak infected hundreds of thousands in Haiti just months after a severe earthquake left more than 100,000 dead. Prior to the outbreak, there were no reported cases of cholera in Haiti.

This summer, the United Nations finally acknowledged that it was involved in the initial outbreak and the profound suffering that has followed.

Cholera is a bacterial infection that can lead to potentially serious symptoms of watery diarrhea, nausea, vomiting and muscle cramps, according to the CDC. Often spread through contaminated water or food, the incubation period of the disease can be as short as two hours, meaning it can move quickly through a densely populated area. As the mucus membrane of the intestinal wall is affected, it can lead to diarrhea that can cause severe dehydration.

The disease appeared in Haiti in October 2010 and spread quickly, causing an estimated 770,000 infections in the years since and approximately 9,200 related deaths, according to a 2016 report in the American Medical Association Journal of Ethics.

Within days of the first diagnosis, the AP reported that local politicians and other residents suspected the source of the outbreak was the human waste entering a river system from a military camp for the United Nations Stabilization Mission in Haiti. A group of peacekeeping soldiers had recently arrived there from Nepal, where cholera is endemic. AP reporters found U.N. investigators testing samples for cholera and a septic tank that was overflowing with broken pipes.

At the time U.N. officials strongly denied the base was linked to the outbreak and reportedly told the AP that no Nepalese soldiers had the disease and that the liquid being tested was from kitchens and showers and not from human waste.

On November 1, 2010, the CDC, working with Haitian public health experts, announced that the strain of the disease was similar to one seen in South Asia.

John Mekalanos, a cholera expert and chairman of Harvard University’s microbiology department, told the AP in a November 3 news report that early evidence suggested military UN members likely brought the disease to Haiti from Nepal where an outbreak had recently been reported.

Dr. Renaud Piarroux, an epidemiologist at the University of Aix-Marseille, then worked on the ground in Haiti with Haitian and French experts in the days and weeks that followed to confirm the source of the outbreak. They quickly identified the U.N. camp as the likely cause of the outbreak.

Piarroux and his co-authors later published a study about the source of the outbreak in Emerging Infectious Diseases medical journal in 2011. The study’s findings “strongly” suggested that the United Nations camp led to the contamination of the Artibonite river and one of its tributaries, which helped to trigger the cholera epidemic. The tributary system was a source of water for bathing, drinking and cooking for those living downstream from the camp. Early findings from Piarroux’s report were published by the AP, in 2010 putting additional pressure on the U.N. to investigate the source of the outbreak.

However, confirmation by officials was hampered since, in the weeks after the outbreak began, officials at the CDC, UN and the World Health Organization said finding the source was not a priority.

“Our primary focus here is to save lives and control the spread of disease,” CDC medical epidemiologist Dr. Jordan Tappero, who was leading the CDC cholera response team in Haiti, said in its that Nov. 1, 2010, press release. “We realize that it’s also important to understand how infectious agents move to new countries. However, we may never know the actual origin of this cholera strain.”

A WHO spokesman told the AP in November 2010 that the question of whether U.N. peacekeepers from Nepal were to blame was “not a priority.” Riots broke out after the U.N. dismissed the allegations about the peacekeeping camp, saying its sanitation was airtight, according to the AP. By December, however, the AP reported that the U.N had relented, calling for a probe into the cause of the outbreak.

In February 2011, independent investigators sent by the United Nations finally arrived in Haiti to examine the possible cause of the outbreak.

Their report, released in May 2011, acknowledged that members of the United Nation Stabilization Mission in Haiti arrived in the country after working in Nepal, where the disease is endemic. They also found that the water system at the camp was “haphazard,” and that human waste was being disposed of near a tributary where the early cholera cases were reported. Furthermore, local hospital staff reported to the U.N. researchers that the first severe cases of cholera came from an area named Meye, which is located 150 meters downstream from the U.N. camp where the soldiers had been staying.

However, that 2011 U.N. report stopped short of putting blame specifically on that camp, going only so far to say there was an “hypothesis” that the source was the soldiers from a cholera-endemic country was “a commonly held belief in Haiti”. The report went on to say that the country of origin of the strain was “debatable” and instead cited multiple factors for the spread of the disease, including the widespread use of the tributary system by Haitians, their lack of immunity to cholera, and the conditions within medical facilities treating the victims.

“The Independent Panel concludes that the Haiti cholera outbreak was caused by the confluence of circumstances as described above, and was not the fault of, or deliberate action of, a group or individual,” the report said.

The United Nations refusal to accept responsibility for the outbreak led to continued demonstrations in Haiti. Members of the medical community also railed against the U.N. for shirking responsibility.

In 2013, researchers from the Yale Law School and the Yale School of Public Health released a report called “Peacekeeping without Accountability” to analyze the actions of the U.N.

“By causing the epidemic and then refusing to provide redress to those affected, the U.N. has breached its commitments to the Government of Haiti, its obligations under international law, and principles of humanitarian relief,” the report authors wrote.

That same year, a number of advocacy groups filed a class-action lawsuit on behalf of five U.S. and Haitian citizens affected by the cholera outbreak against the U.N. and certain U.N. officials alleging they were responsible. A United States District Judge found that the U.N. had immunity from prosecution, according to court documents.

The decision was appealed this year but the original decision was affirmed. The plaintiffs have until mid-November to decide whether to appeal to the U.S. Supreme Court.

Then, this past August, The New York Times broke the news of a confidential report from New York University law professor and U.N. special rapporteur, Philip Alston, to U.N. Secretary-General Ban Ki-moon. In his report, Alston wrote, “The fact is that cholera would not have broken out but for the actions of the United Nations.”

Shortly after that report was made public, the United Nations finally acknowledged that its personnel likely played a part in the Haitian cholera outbreak. “Over the past year, the U.N. has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera,” Farhan Haq, deputy spokesman for the U.N. secretary-general, told reporters on August 18.

The following day, Haq said, “The Secretary-General deeply regrets the terrible suffering the people of Haiti have endured as a result of the cholera epidemic.” “The United Nations has a moral responsibility to the victims of the cholera epidemic and for supporting Haiti in overcoming the epidemic and building sound water, sanitation and health systems.”

Piarroux, the lead author of the 2011 study published in Emerging Infectious Diseases, wrote an op-ed in The New York Times in September, decrying the United Nations for taking so long to acknowledge its role and respond to the crisis.

“By admitting that it was involved in the outbreak, the United Nations made only a first and timid step toward a full assessment of its responsibility,” he wrote. “The United Nations must continue to open up about what happened in Haiti, rectify the damage, and establish policies that prevent such disasters in the future. Its credibility is still on the line.”

A spokesman for the U.N. secretary-general told ABC News a full presentation on the assistance and support to combat the Haitian cholera outbreak will be presented later this month.

Today, the U.N. camp at the center of the outbreak controversy is no longer fully functional and has no military members, according to a spokesperson for the U.N.’s Departments of Peacekeeping and Field Support.

Since the 2010 outbreak, the U.N. Stabilization Mission in Haiti has pursued a multi-pronged course of action to adequately deal with the waste management of its peacekeeping forces. It was not until October, 2015, that the U.N.’s oversight services department found the Mission to be in compliance with all of the recommended procedures.

In addition, as of late 2013, the peacekeeping forces have been supporting the Haitian government in its long-term plan to eradicate cholera.

In the meantime, in Haiti today, cholera remains stubbornly endemic. This week, the Pan American Health Organization reported there have been 1,351 suspected cases of cholera identified since Hurricane Matthew hit the country. PAHO has identified the disease as a main priority in the storm’s aftermath.

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Knee Injuries Nothing to Sniff At: Nasal Cartilage Grafts Used to Help Sore Knees

iStock/Thinkstock(NEW YORK) — Millions of Americans suffer from painful knee joints as a result from damaged knee cartilage. Damage can produce severe pain, and if left untreated, it can spread to involve the whole surface of the bone in the knee, which eventually leads to painful and damaging osteoarthritis. But there could be hope: In a new small study published in the Lancet today from Swiss researchers, surgeons are using nasal cartilage to help patch up knees.

Researchers from the University Hospital Basel in Switzerland performed a small study on 10 patients to see if nasal cartilage may help damaged knees.

Helping repair injured knees can be key for keeping adults healthy later in life. Nearly one in two Americans may develop painful knee joints by the time they reach the age of 85. For physically active individuals or professional athletes the damage may start decades before, leading to severe pain.

The researchers extracted cartilage-producing cells called chondrocytes from the noses of patients and seeded them on a collagen membrane in a lab for two weeks. These cells grew into cartilage, which the researchers then grafted into the knees of the patients. They then followed up with nine of the patients for two years to see if they were satisfied with the results and evaluated the quality of the cartilage with imaging. One patient suffered a sports injury during the trial, which necessitated doctors re-doing the procedure, and his results were not included in the final report.

“We’re trying to prevent the onset of osteoarthritis,” Dr. Ivan Martin, study co-author and professor of tissue engineering at the Institute for Surgical Research and Hospital Management at the University Hospital Basel in Switzerland, told ABC News. “For the first time, cells taken from nasal cartilage were transferred to the knee.”

Martin said the patients mainly had injuries from recent trauma, including car and ski accidents.

While harvesting cartilage from the knee to then graft onto damaged cartilage is a common procedure in the U.S., nasal cartilage had not been used in this manner before.

Dr. Riley Williams, director of the Institute for Cartilage Repair at Hospital for Special Surgery, associate professor at Weill Cornell Medical College and an orthopedic surgeon who has used cartilage cells from the knee to fix ankles hips and shoulders, said there is potential for this experimental procedure.

“Nasal cartilage is hyaline cartilage same as is found in the knee, so I’m not surprised it would form new hyaline cartilage when transplanted into the knee, so it should over time mature to cartilage-like tissue,” he said.

The researchers found that the cartilage from the nasal septum not only integrated well with the surrounding tissue but also appeared to be better quality in comparison to transplanted knee cartilage.

Martin said that the study is still preliminary and more research needs to be done but that MRI data from the small study shows “the composition of our patients’ [cartilage] is better than reported in other studies.”

The researchers also found that the quality of these nasal cartilage grafts improved over time as the cartilage cells matured.

While the study officially followed patients for up to two years, “The first patient reached three-and-a-half years after the procedure, and they’re still doing very well,” Martin said.

That patient, identified as Salome, told ABC News the procedure has helped her stay active.

“My cartilage damage was quite severe,” said Salome of her knee before the procedure. “Before this operation, I could not do normal work in the household, I could only stand for an hour before my knee swelled up. I can now stand for up to six hours. I now do Zumba!”

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Mom Uses IVF to Protect Daughter From BRCA Mutation

Photodisc/Thinkstock(NEW YORK) — Growing up, Lindsay Avner saw firsthand the devastating toll breast and ovarian cancer could take on a family. Her grandmother and great-grandmother passed away from cancer before she was born and her mother was treated for breast and ovarian cancer when she was just 12 years old.

She underwent testing at the age of 22 to find out if she had a mutation on the BRCA gene that is associated with an increased risk of breast and ovarian cancer. She ultimately tested positive for the BRCA1 gene, meaning she had a 55 to 70 percent chance of developing breast cancer and approximately a 40 percent chance of developing ovarian cancer, according to medical literature.

For comparison, the risk of developing breast cancer is approximately 12 percent and the risk of developing ovarian cancer is just 1 percent in the general population.

After her diagnosis, Avner was proactive about her health. She told ABC News earlier about her decision to undergo a double mastectomy at age 23 to reduce her risk of breast cancer. She also started a non-profit called “Bright Pink” that focused on the prevention and early detection of breast and ovarian cancer in young women.

At age 30 she had eggs frozen in case she wanted to go through a second preventative surgery to remove her ovaries before she had children.

But last year she had to debate a new kind of preventative measure: undergoing IVF to stop the BRCA1 gene from affecting her future children.

Fertility doctors are now able to test embryos to detect any BRCA mutation in a process called “preimplantation genetic diagnosis.” After a woman undergoes an IVF cycle, the resulting embryos can be tested for the BRCA gene mutation and the patient can then decide whether or not to implant that embryo.

Avner said her husband was the one who pushed her to take the test.

“He said, ‘Are you out of your mind, you’ve seen cancer up close and personal,'” Avner told ABC News. “He was the one who was like ‘We have this opportunity, you preached being proactive.'”

Avner’s husband Gregg Kaplan and his three teenage children know the BRCA gene well. Kaplan’s first wife was told she carried the BRCA mutation after being diagnosed with breast cancer. She later died from the disease and Avner said her three teenage stepchildren will likely be tested for the BRCA gene mutation in the future.

As they discussed fertility options, Avner recalled her husband saying, “Here is the greatest gift we can give our future child.”

According to fertility doctors, the growing popularity of BRCA testing has led many young women to talk about their fertility options. It can be a fraught and complicated topic, since some women are not ready to have children and are still grappling with the BRCA diagnosis.

“We’ve known about the BRCA gene for about 20 years,” said Dr. Elisa Port, chief of breast surgery at the Mount Sinai Hospital in New York. “This is the first generation of BRCA carriers who are of childbearing age for whom this technology and this intervention is feasible.”

In addition to the financial expense and the emotional experience of having to wait to see if an implanted embryo successfully develops into a pregnancy, women with the BRCA gene may face additional fertility issues. Some studies have appeared to show that women with the genetic mutation have a decreased ovarian reserve and earlier menopause, but the data is mixed, according to Dr. Matthew Lederman, reproductive endocrinologist and infertility specialist at the Division of Reproductive Endocrinology and Infertility of Mount Sinai Hospital.

“They’re coming in younger knowing that they have BRCA mutation and they want to talk about freezing eggs and embryos,” Lederman said.

After deciding to pursue IVF, Avner went through two cycles of egg retrieval.

“My egg reserve had dropped so dramatically from age 30 to 33,” Avner said. “At that time my doctor was like, ‘I don’t understand I want to do another test.'”

Avner said her doctor advised Avner to start IVF immediately in order to boost her chance of having a child. The couple ended up with just four viable embryos without the BRCA mutation.

“We were so blessed that the first embryo worked,” Avner said. “Lucy was born on Sept. 30. She is insanely perfect, it is remarkable to look at her for many reasons…it’s such a dream come true.”

Avner, 34, said she hopes to have another child within the next 18 months and then will immediately have surgery to remove her ovaries. It’s a preventative measure that she is thankful her daughter will not have to grapple with in her life.

“When we look at Lucy it’s so hopeful,” she said. “Eleven women in my family have died from breast or ovarian cancer…the buck stops here and it’s so remarkable.”

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Determined Father With Multiple Sclerosis Uses Exoskeleton to Walk Daughter Down Wedding Aisle

iStock/Thinkstock(NEW YORK) — A 54-year-old man with multiple sclerosis recently awed 200 guests at his daughter’s wedding, where they saw him walk for the first time in over 20 years.

The moment was “timed perfectly,” said 28-year-old bride Elise Holland.

She explained that her father, Scott Holland, had been sitting and hiding behind a partition in the Manayunk, Philadelphia, venue before the ceremony started. But once she arrived, Scott Holland suddenly rose and emerged from behind the partition.

Then, donning an exoskeleton attached to his back, Scott Holland walked his daughter down the aisle. She was smiling and teary-eyed the whole way.

“The whole room was just taken aback and everyone was in tears,” Elise Holland told ABC News. “It completely caught everyone off-guard since no one except my family and I had known he was going to walk the aisle.”

The bride said the incredible feat was the culmination of over four months of rigorous physical therapy.

“Once he had the idea that he could with an exoskeleton in his head, he just went and ran with it,” Elise Holland said with a laugh. “‘Tenacious’ is definitely one word to describe him, and so is stubborn … definitely stubborn.”

Elise Holland was only 2 years old when her father was diagnosed with MS over 26 years ago, she said.

“But rather than sitting there thinking, ‘Woe is me,’ he just really made the most of everything he had,” the bride said. “He taught us the power of adaptability.”

Elise Holland said that before MS, her father used to be a “very serious runner.” After it, he turned his love of running into a love of cycling for quite a few years.

“He’s never let MS stop him from doing what he wants,” she said. “Although he has MS, he isn’t MS. He doesn’t let his condition define him. At the end of the day, he’s still just Scott — a truly and genuinely amazing person.

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Vermont Governor Pushes to Limit Prescription Painkillers to Combat Opioid Epidemic

backpack555/iStock/Thinkstock(MONTPELIER, Vt.) — The governor of Vermont announced Wednesday a proposal to limit the number of painkillers prescribed in an effort to combat the crippling opioid epidemic that has devastated the state in recent years.

“Vermont, and the rest of America, will not get a handle on the opiate and heroin addiction crisis until we confront head-on the source of the problem: FDA-approved opiates that are handed out like candy,” Gov. Peter Shumlin said in a statement.

“Vermont doctors and providers have been on the leading edge of curbing the irrational exuberance with which opiates are handed out. These proposed limits will solidify that progress and help Vermont continue to lead the nation when it comes to combating this crisis,” Shumlin added.

Earlier this year, the governor went after the FDA and pharmaceutical industry in his State of the State address, saying Oxycontin “lit the match that ignited America’s opiate and heroin addiction crisis.”

“Just a few months ago, the FDA approved Oxycontin for kids. You can’t make this stuff up. The $11 billion a year opiate industry in America knows no shame,” Shumlin said, adding that “opiate addiction is the one thing that could destroy Vermont as we know it.”

The proposal, which could be official by December, sets legal limits on the number of opioids that may be prescribed. It also requires prescription providers to discuss risks, provide an education sheet to the patient and receive an informed consent for all first-time opioid prescriptions.

“We must flip the presumption that a patient needs opioids to manage pain. The rule allows doctors to make decisions with their patients, while requiring them to consider other treatments before opioids are prescribed, rather than as a last resort. And when opioids are prescribed, they can be prescribed for as much as a patient needs — but not more than they need,” the state’s health commissioner, Dr. Harry Chen, said in a statement.

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Young People Pen Positive Letters to Their Future Selves in ‘Dear Future Me’

Reach Out(NEW YORK) — When two students asked their peers to write positive letters to their future selves, the responses — captured in a video titled, “Dear Future Me” — were eye-opening and heartwarming.

One student wrote, “Dear future me, here’s a couple of things I wanted to let you know. I hope you’re smiling more. … I hope that you’re consistently happier.”

Another said, “Every now and then you’re going to need to put yourself first and do your own thing and that’s OK.” A third student wrote, “Don’t lose who you are and always be who you want to be.”

The students, Meghan and Alice, were working on behalf of ReachOut, a nonprofit based in Ireland that helps youths improve their mental health. “Dear Future Me” is part of its “Note to Self” campaign.

“It’s a campaign that we’ve been doing on college campuses around the country in Ireland,” Naoise Kavanagh, ReachOut’s communication manager, told ABC News. “Where we go and have postcards and … ask [students] to write positive, inspiring messages to their future selves. And then we mail them back to them at an unknown date.”

Kavanagh said the aim of the campaign, which launched a few years ago and has expanded to California, is to “help young people.”

“‘Note to Self’ shows people that sometimes we have the answers for ourselves,” she added.

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Your Body: Dealing with Sleep Deprivation

iStock/ThinkstockBy DR. JENNIFER ASHTON, ABC News Senior Medical Contributor

While some people claim they function perfectly on less than six hours of sleep, researchers have found that this may not actually be the case.

A new study in Brain and Behavior looked at patterns in the brain of chronically sleep-deprived people and found they may not be aware of how impaired they are once the sun is up. Researchers found that when compared to conventional sleepers who got more than seven hours of shuteye, the short sleepers exhibited diminished wakefulness.

So here’s how you can aim for more than seven hours. Make your sleep a priority. Set a regular bedtime and wake time, give or take an hour, and stick to it. And lastly, make sure your bedroom environment is cold, dark, and quiet. It really does help.

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Woman Gives Birth at Age 62

iStock/Thinkstock(LUGO, Spain) — A woman in Spain says she feels “phenomenal” after she delivered her third child at the age of 62.

The Telegraph reports that Lina Alvarez, of the Galician city of Lugo, left Lucas Augusti Hospital on Tuesday with her week-old daughter, telling reporters, “I couldn’t be better. I’m very, very grateful to life for such a precious little thing.”

Lina, who shares her mother’s name, was born two weeks early after Alvarez had a cesarean section. The baby weighed more than five pounds.

As she left the hospital, Alvarez said, “I’m looking forward to resting for at least a couple of days now so I can enjoy time with my daughter and recover.”

Alvarez had in vitro fertilization to conceive her daughter. Ten years ago, she had the IVF procedure and delivered a son at the age of 52. She has caused a great deal of debate about age and IVF in her native country.

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Teen in Wheelchair Stands for American Flag

Courtesy Myron Leggett(NEW YORK) — Arek Trenholm was born with a condition called spina bifida, which impairs the development of the spinal cord.

The 16-year-old has been wheelchair-bound for 10 years now. But at the site of the red, white and blue, he hoisted himself up to pay homage.

The teen and his family were outside his uncle Myron Leggett’s photography studio in Leesburg, Florida to watch a high school homecoming parade. It was when the junior ROTC marched by with the American flag that he used his arms to rise up out of his wheelchair.

Leggett, a professional photographer, was the one to capture the moment.

“My sister just called out, ‘He’s standing!’ And instantly, I knew what he was doing,” Leggett told ABC News.

Arek is known in his family as the young patriot. His mother, Deree Trenholm, said that despite his disability, he’s been standing for national anthems, pledges and flags since he was very young.

She said he always chooses leg braces with the American flag on them. He now has 10 pairs.

Leggett posted the photo to his Facebook and received many comments applauding Arek for his show of respect.

“He didn’t have to do that. He has an excuse to stay seated,” said Leggett. “Nobody told him, nobody encouraged him and he did it on his own. I admire him for that and I’m very proud of him.”

Arek’s mother hopes his picture will spread awareness about the spinal disorder for National Spina Bifida Awareness month, which is this month.

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Bats Proposed as Latest Weapon to Fight Zika Virus in Miami

iStock/Thinkstock(MIAMI) — One Miami city official has an unusual proposal to combat the spread of the Zika virus. City Commissioner Kristin Rosen Gonzalez has proposed using bats, which eat mosquitoes, including the species known to spread the virus.

“Some people are laughing and they are not taking it seriously. But bats, depending on the species, eat up to 3,000 mosquitoes in one day, and they avoid humans,” Gonzalez told ABC News. She has sponsored a resolution that proposes placing bat houses in the city to curb the mosquito population.

The first outbreak of locally transmitted Zika virus was reported in Miami in July. In the months since, city officials have continued to battle the ongoing outbreak, which has infected dozens in the Miami-area. Larvacide, insecticide and door-to-door inspections have all been used to try and reduce the population of the Aedes aegypti mosquito that spreads the Zika virus.

The resolution seeks to authorize the city manager to “research a potential pilot program for the placement of bat houses and habitats in the city to control the city’s mosquito population due to the continued presence of mosquitoes carrying the Zika virus.” The measure was discussed at the commissioners meeting Wednesday.

“It was a goodwill gesture to the environmentalists, who were really upset about us spraying all the neurotoxins,” Gonzalez said of her resolution, but added that she isn’t sure if it will be adopted because “it makes people nervous.”

The Miami City Commission reviewed the resolution Wednesday and passed it to Miami-Dade County, which holds the authority to either adopt or reject the resolution.

The measure of floated as an alternative to spraying chemicals, Gonzalez said, adding: “This was really the one environmental solution.”

The American Mosquito Control Association notes on its website that bats have historically not been an effective method of curbing mosquito populations, and that mosquitoes comprise less than 1 percent of gut contents of wild-caught bats, saying that bats feed on “whatever food source presents itself.”

“There is no question that bats eat mosquitoes, but to utilize them as the sole measure of control would be folly indeed,” the AMCA states, “particularly considering the capacity of both mosquitoes and bats to transmit diseases.”

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