Mold and Other Risks in the Home in:

"Is Your House Is there mold in your house getting to you? Discovery Health Channel - Toxic mold and other risks in the home. Out to Get You? "

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Is mold in your house out to get you? See the Discovery Channel Special December 15 

 Josef Dumanov Medical Mycologist J Dumanov Pathologist in Diagnostic Medical Mycology

CLINICAL INDUSTRIAL HYGIENISTS FOR MOLD AND INDOOR ENVIRONMENTAL HEALTH RISK INVESTIGATIONS
PRESS RELEASE:   TOXIC MOLD IN THE NEWS
NEW JERSEY INDOOR ENVIRONMENTAL HEALTH SCIENCES
mycological intitute mold in human habitations
 
Is there a possibility that clinically relevant fungi, mold or other dangers may be in your cupboard, basement, attic or concealed in the floor, walls or ceiling damaging your home or affecting your family's health?
See: The Discovery Health Channel's Special:
Is Your House Out to Get You?

NEW JERSEY SCIENTIST APPEARS IN DISCOVERY HEALTH CHANNEL SHOW:
DISCUSSING RISKS OF TOXIC AND PATHOGENIC MOLD AND THE ROLE OF SUCH FUNGI IN HUMAN HABITATIONS AND HUMAN HEALTH

 

Press Release Dec 7, 2005 TV Special with Professor Dr. J Dumanov, Esq, is a medical expert in the field of clinical environmental epidemiology. As clinical research pathologist in diagnostic medical mycology, toxicology and as Certified Clinical Industrial Hygienist™ (CCIH CERTIFIED CLINICAL INDUSTRIAL HYGIENIST *) specializing in the field of  allergenic, toxigenic, pathogenic and infectious fungi, molds and their pleomorphs within human habitations relevant to human and animal health. The nationally and internationally recognized scientist (clinical molecular biology) conducts indoor health risks research and investigative studiesfor federal, state and local government and the private sectors. Also as a clinical medcial research scientist, licensed electronics and communications engineer (RCA NYC & Sarnoff Institute Princeton NJ) conductiing EMF EMI and 5G risk exposure, lecturer and legal counsellor (private-atorney general civil right law) he has trained, certified and provided consultation to thousands of professionals including medical doctors, clinical researchers attorneys at bar, academics, real estate, commercial, industrial and related fields where mold poses health or legal questions.

He studies homes, schools, offices and industrial sites as biological enteties that contain biological and environmental health risk factors.. Since 2003 has been refereed to as the "America's House Doctor" where his patients are often identified in "sick" residential homes finding toxins, EMF radiation, bacteria in houses, buildings and other habitations. Working with the patient's medical doctors he is routinely called by those suffering from the cancers, allergies, asthma, Lyme, multiple sclerosis or infected medical patients. He conducts subClinical™ investigations and makes a "diagnosis"of the patients environment. If there is a concern or problem he prescribes a "treatment"   for the habitation as need. He appears in the coming December 15 at 8 and 11 PM  Discovery Health Channel show entitled "Is Your House Out to Get You?" Rebroadcast December 17 at 1 PM. (If you are reading this at a later date check your local cable listing for a repeat showing or obtain the DVD when available from the Discovery Health Channel).

Scientists, doctors and researchers in the show uncover many of the potential risks hidden in the home including possibilities for burns, shocks and explosions from appliances and more. With mold getting so much attention from an infection in Ed McMahon's dog to Bianca Jagger's loss of habitability of her New York City apartment the interest in mold is at an all time high.

Our mycologist discusses some of his cases and talks about the risks and hazards associated with mold within the home or workplace. This includes the possibility of getting sick from contacting mold spores and fragments, touching mold covered items and damage to the home itself.

Important topics are covered especially for the first time home owner. Get the family together and get ready to watch "Is Your House Out to Get You?" on Thursday, December 15 8 PM and other dates/times - see your local cable or satellite listings.

In what turned out to be not only an exclusive 2 hour recorded interview (edits with permission. Ed.)  with the professor, also turned out to be quite startling with his revelations of discoveries in his unpublished research. We conducted this interview shortly after the final taping of this show in midtown Manhattan we asked Dumanov  subclinical Research Institute what do we know about mold fungi in the home and what is science telling us:

Are there true risks associated with mold in the home? "Simply, a fungal mold has no place within human habitations and has no proper place in home or workplace especially if it poses a health risk. Scientifically, all fungi have only one role in the grand scheme of things as a catabolic molecular processor and that is to digest and break down organic matter and complex molecular formations into their simplest forms for recycling. In doing so the fungi produce some interesting chemistry and problems in the process."

So what are the problems associated with molds? "Generally two things are the problem, the target of the catabolic process and the resulting by products of that process. First, it is OK for mold to grow on cheese such as Brie, Camembert or Roquefort, but when you have it growing on and digesting your clothing, shoes, furniture or your house then you have a problem. Second are the by products formed such as the allergenic, neurotoxic, cytotoxic, genotoxic and pathogenic secondary metabolites and extrolites that are produced. Although less often there are the many possible fungal mold related infections, diseases and immune responses when they invade human or animal tissue."

What are the effects of these mold toxins? "The range of effects of toxins from mold are interesting. The penicillin vaccine is a toxin produced by Penicillium notatum, by some of the Aspergilli and other fungal molds that has saved countless lives - that toxin targets nasty bacteria. Some toxins cause  unexplained fatigue, neurological distress and responses including but rarely hallucinations. Cytotoxic, pathogenic and genotoxic toxins are at the focal point for research in human health and their effect on humans is much too often unrecognized or   misunderstood by many indoor environmentalists.

Should we be afraid of mold? "Clearly the medical literature documents mold as an etiological agent (cause, Ed.) for many human health conditions. A recent publication (Fungalbionics) by the American A.V. Costantini, MD from the UN's World Health Organization Center for the Study of Mycotoxins in Food in a collaborative work with an international team in a collection involving hundreds of studies document the deuteromycota, the fungal mold and their toxins involved as the cause of many diseases. Medical mycologists will not culture some of these fungi in the lab because they pose such a high risk and danger for infection and death. But for a human of average health living in a dry mold free environment the risk is limited and they need not be concerned. "

How common are mold diseases? "We encounter infected humans and their animals from time to time that have fungal disease. A disease caused by fungi is called a mycosis. Often a fungal exposure or infection results in a mycosis, abscess, necrosis or a fibroid immune response to the presence of fungi is sometimes called a tumor or cancer. Two of my recent studies involved a 26 year old female with a large mold growth in her left lung that required surgical removal and a 65 year old male with a brain "cancer" that was later diagnosed as being 2 different fungal mold growths. She fully recovered. His condition after excision is currently considered hopeful. In our investigation we found their homes were fully contaminated with the genus and species involved in their disease in spite of the previous 2 "mold inspections" stating there was "no mold". In just the last few weeks we took on a new case involving a 40 year old female with a bleeding nose, possibly due to fungal mold enzymatic necrosis. In our research pathology I was able to identify both the genus and specie of fungi known as Aspergillus terreus in the tissue samples and our toxicological research associates with further analysis and serum assay were able to identify the specific mycotoxins in the tissue samples. "

Who is at most risk? "It is about dosage of  specific mycotoxins and exposure to specific fungal molds and the human's health status. Genetically about 25% of the population has an innate sensitivity to fungal mold and other contributing factors. Some groups are clearly more vulnerable. The humans most at risk are neonates, infants, elderly, diabetics and those that have become neutropenic (low white blood cell count) or immunocompromised for many reasons including cancer patients that have received chemo or radiation therapy and those that have been on prolonged regimen of antibiotic or transplant suppression   therapy. We well know many mold toxins have the ability to damage the immune system. It is very important to keep any open wounds clean and properly treated. Infections from fungal mold are surprisingly common not just from airborne mold but also from food and water. If you are told by your physician your are allergic to penicillin then you clearly have an increased sensitivity to the genera (families) of fungal mold that produce that toxin.  But what is even more interesting is that the presence of some of these fungal molds may be related to yeast infections in humans. "

This is the first I have heard of yeast infection being associated with mold. " Medical mycologists and physicians understand that yeasts  such as the common Candidas are just a different form of the same fungi. There are many fungal  molds that can turn into a yeast and some of these yeasts turn into a mold. We see this routinely in the laboratory. It is a phenomena called dimorphism, some of these fungi will also take on additional forms and are known as pleomorphs. This has been observed for over a 100 years and we now fully understood how and why these various morphologies come into being.  Be aware that the so-called "Athletes' Foot " condition is a mold/yeast infection and can be contracted if barefoot at home or in the gym if these fungi are present clinically diagnosed as onychomycosis. If you have repeated foot infection throw away your footwear as it is most likely the source and harbor for these fungi and of the reinfection. "

You mentioned pregnancy as a factor. "Yes, during pregnancy olfactory sensitivity is increased for many reason and the are immunological and hormonal changes that occur resulting in amplified response to environmental factors and sensitivities especially to fungi, their toxins and especially from mold that are not experienced by males. During pregnancy a safe, healthy and mold toxin free environment is mandatory for proper fetal development - this is why females are often asked if they are pregnant so to avoid alcohol, a mold toxin, along with certain foods and medications that may affect such development. This sensitively does diminish over time but the risk and environmental burden if present in the home is now on the homecoming newborn. Do not bring a newborn into a potentially hazardous or toxic home environment-this is not to be taken lightly, if you, a grown up or any adult family members gets sick in the home and feel better outdoors or away you have a problem and a with an undeveloped immune system, a newborn is nearly defenseless. The medical studies are clear and this information is well documented on the web."

How can I tell if there is a mold problem in my house? "I first want start off by saying that people often tell me every house has mold-that is totally false. I have investigated homes that are over 300 years in the US and over 500 years and older in the UK and the EU with absolutely no fungi or mold presence. I also see brand new homes that have mold built right in because the construction materials were left in the rain, mold grew on it and was used to complete the construction."

"Now to go to your question about identifying a mold presence in the home. Often you can see mold and or smell it but sometimes it is odorless to you or there are minimal sensory indicators. In one of our recent studies (Co. Sussex,NJ) a home owner found they had a mold problem because their dog was diagnosed by a veterinarian with a mold infection and put on the antifungal Itraconazole (Sporanox) for pets. Her physician later determined she was also mold infected. The house was later found to contain hundreds of square feet of mold in the walls, floor and ceiling that was concealed by the seller of the recently purchased home and not noted or suspected by the home inspector. Numerous law suits were filed against sellers, inspectors, remediation companies and real estate agents-they all had a responsibility to have this property competently inspected-the odor was obvious and you could see the mold. "

Do you also find this problem in apartments? "A little less so than in single family houses mainly because apartments have no cellars or attics since these areas are common harbors and reservoirs with the potential for mold growth. Mold can be found anywhere and especially in damp basements where it is hidden in the wall. In habitations such as apartments you will find mold most often in kitchen and bathroom ceilings, walls and floors especially if there have been leaking steam or water pipes. Another good place to look is about the dish or clothes washer if you have one."

Do you ever find it in the office or workplace? "We often investigate child care centers, health care and medical offices but rarely investigate the workplace such as manufacturing or related process environments due to the high level of industry, state and federal regulations that control those environments so in theory these places are very safe. From time to time and under special circumstances we accept such investigations for medical and health research purposes often on the behalf of the state or other interests due to our investigative expertise in environmental toxicology relating to mold. Some of the most interesting investigations and findings have been conducted and revealed  where people are working due to the specialized and concentrated activity in the nature of the business. This is especially true in food processing areas that are not properly maintained. A recent case involving a 175,000 square foot executive office building of a bank that housed hundreds of workers we found duct work fully contaminated with mold associated with kitchen cafeteria operation. Upon entry at the reception area the mold odor was immediately  detected but almost unnoticed by the majority of workers yet symptomatic complaints were widely reported.  We found fungal mold to be present throughout the building."

"It is highly recommended that prior to taking occupancy of any new building that management have a full investigation of the indoor environment with a focal point for fungi, mold and bacteria especially if there is any history of water damage. We see many instances where companies move into a new office that has mold or other indoor air quality issues. I continuously advise management that any and all new offices be fully investigated before moving workers to a new location since poor indoor air quality or mold presence affects performance, production and does account for lost work days. I also recommend that management take note and observe their employees for indicators that there may be a problem by listening to complaints and acting promptly with a qualified and certified health risk investigation."

What are the symptoms of mold exposure? "Depends on many factors. Your personal health status such as the pregnancy mentioned, the amount of mold, duration of exposure and the species of mold you are being exposed to is very critical. Chronic fatigue syndrome is commonly associated with toxic fungi. There is also a long list of exposure symptoms of which allergic bronchopulmonary responses are common and immediate type one responses with watery eyes, coughing and sneezing often upon the mere entry into a room with mold present. Long term symptoms may include, pyrexia (fever), peritonitis (stomach pain), lymphadenopathy and melioidosis (swollen lymphs or glands), headache, chills, sleep disturbance, cutaneous (skin) lesions, sinusitis, itching, and more. Other times humans experience a delayed type two response six or more hours then have resulting flu like symptoms that may last for weeks. Then there are other exposures that result in asymptomatic responses - you will have to attend one of my lectures. If your physician believes you have been exposed they may order or perform immunological tests or require serum samples to be sent to a laboratory that will tell if you have had any significant mold exposure to toxins."

What tests are there available? "We give guidance and consultation from time to time to medical doctors new to practical medical mycology. There are many different tests available that your physician can prescribe if there are indications that the tests are called for. If your home or habitation was investigated and there is history of water damage or a significant mold presence you should provide a qualified investigation report to your physician and allow the physician to determine relevancy to your health. Your immune system typically responds with elevated IgE and IgG and other antibodies in both salvia and blood when exposed to members of the genus Aspergillus and Penicillium, both are a common allergenic fungal mold group. Skin prick tests (SPT) and Enzyme Linked Immuno-Sorbent Assays (ELISA) will help to determine your mold and other sensitivities (allergens) and exposure to clinically relevant fungi or mold. There are other tests, markers and indicators of exposure and infection including the use of a fungal mold PCR panel, blood serum (plasma) analysis that your physician, allergist or immunologist will screen you for and may order such tests and others if such indicators of exposure or illness are present. Medical doctors must also be mindful that some tests that indicate false positives. "

How about testing my home? Should people test their own homes. I hear it's easy? "I always shake my head when I hear about testing. Testing is a methodical scientific process considering many complex factors starting with the host. Nearly all testing on your own is pointless. The common mold kits you buy can be taken anywhere and something will grow and it will be a fungi or fungal mold of some kind and even the possibility of algae, plants, yeasts and bacteria. The often misunderstood and misused air test kits too are a problem, just like the sample kits they are not being used correctly or appropriately in nearly all cases reviewed. As an example I was called in a legal matter to review a recent inspection where the mold spore counts were in the millions for an air sample, such a count is not normally possible. I later interviewed the "mold inspector" that did the testing and he disclosed that he placed the air sampler right on top of the mold forcing into the air cell and representing it as an "air sample" - I am an advocate for rigorous training and qualified certification for this practice. Internet mold inspection diploma mills or correspondence courses just don't provide adequate training or experience for investigating when there is a true health risk present. "

So how should one use a mold test or sampling kit? "There are so many different ones available each used for very specific purposes. I could talk about tests kits ad nauseam. Test kits in the hands of a non scientist have little value other than telling you what we all know already that mold spores and fragments are normally present everywhere. Without fully understanding this simple fact and what it means to an investigator or inspector leads to more confusion and most cases unnecessary alarm, confusion, distress and expense. Key questions have to be formulated for every investigation before any testing is to be considered. If you have the potential for a fungal mold related health problem nothing less than a fully qualified scientific study must be performed. Simply just because you have mold growing on a "test kit" does not mean you have a mold problem. "

"People need to be aware that fungal mold is often the same color or offers little to no contrast to the background making that mold undetectable. A recent case in Monmouth county had such a presence of a very nasty mold with a young occupant with a mold infection that was later identified in the home in a massive but unseen presence. Another case involved a newer construction of about 5 years that had no water leaks but presented extensive growth with hundreds of square feet of a fungal mold  known as Aspergillus that was the same color as the surface of the construction material almost totally invisible to the untrained eye that revealed by special lighting then sampling identified it  to pathogenic. "

Aspergillus. You mention these molds by name. Why should I know what they are? "I know, we are often told by people that do mold clean up it does not matter and just clean it. Well in cases that is true if you do not have a health issue or if it is a simple case with fungal mold about the sink or tub. If there is a health issue or concern such as a related allergy, respiratory condition or even an infection then you must know the allergen or pathogen, advise your physician and then making your known exposure part of your medical history and record. Knowing that these fungi can and do a times cause serious health injury or disease you certainly must know which ones they are. We provide an important clinical section in our  reports that is directed to the attending physician to complement their diagnosis of such indicators. "

"You also want to know whether these fungi pose a health risk so that the workers are adequately protected and the proper procedures are implemented in the remediation such as full containment and control.  In the case where the mold poses no problem as in the majority cases the remediation may only cost you a fraction of what it may cost if you have a presence of a mold that poses high risk or possible health injury  to workers.  If the mold presence is benign it may even be something you can do on your own saving you hundreds to tens of thousands of dollars. On the other hand if you have a limited presence of a potentially infectious fungi your biggest risk is spreading it throughout the property. Only a fully qualified specialist can determine the difference and relevancy to your experience. Obtain a health based investigation since a general home or mold inspection is not designed for and is not adequate for health purposes. This also true for legal purposes. Normal mold inspections do little to nothing for health, forensic or legal purposes. "

Tell me about the differences in investigation for legal purposes. "I found law interesting enough to take a paralegal degree earlier in my career (later for JD) and it turned out to be essential in my current medical research practice as it has helped me to understand the evidentiary burdens the law places on the scientific standards relating to claims associated with mold and health injury claims. Too many false positive, too many false negatives. Simply, it gets far more complicated when trying to tie health claims and legal claims. Ultimately as both a health  and legal investigator  I have the advantage of knowledge in both areas and often provide guidance and direction to clients and their attorneys regarding the medical and indoor environmental tests that must be performed.  It is very unfortunate when people have a bona fide case or a real case,  that is to say a winnable case and just do not meet the legal evidentiary standards and their cases are dismissed. I also see cases going on for years and then review them before trial for the client or their legal counsel, review the medical and investigative record and there is really nothing there but the wrong medical lab testing and a pointless "mold inspection" citing hearsay within hearsay and without a cohesive and comprehensive interpretation. On the other hand in other similar situations I conduct an investigation or inspection connected with the medical findings, write a report that is submitted to the triers of the facts be it in court or other tribunal such as for workers compensation or insurance and then the case ends of a petitioner or plaintiff or is settled immediately. If you can not definitively tie in the applicable environmental testing with the medical tests and clinical record you will lose a lot of time, effort and expense resulting in a dismissal. Unfortunately for litigants I see plaintiffs and defendants that lose cases that could have been easily won. Attorneys and clients routinely consult me reviewing the evidence for trial or the record for appeal. Failing to make the record at trial is nearly always fatal on appeal without a de novo hearing. " 

Lets go back to mold. Will a filter, ion or ozone machine in my home help if I think I have odors or mold? "When it comes to odors, indoor air quality issues or  relating to mold presence there are no simple answers to what will provide you a benefit in any environment. These may benefit you or not. Indoor environments can become very complex. Some people use ozone generators, in some cases these generators will actually make your home more toxic and dangerous and damage your health and furnishings if not used properly. Be careful and selective before introducing any new system especially ozone. Obtain a expert study, opinion and recommendation before installing such a system. Do not turn your indoor environment and the air your breathe into a uncontrolled laboratory experiment."

So what do I do if I have odors or come home from work and get sick all the time? "You made the first critical observation and that is the connection with the place that is giving you the problem. We see this all the time. Once you have firmly concluded it is your home that is giving you the problem then its time for a full indoor environmental assessment. That is where the science comes in. Unfortunately there are no simple ways of testing and it does require a high level of expertise, instrumentation and applicable science. Fortunately in all of my cases the causative agents are identified within hours."

Are there any new developments in medical mycology? "News moves prudently in the sciences and even more so in life sciences pertaining to human health. In the field of genomics, molecular biologists made a key finding based upon the DNA of a bacteria. One of the causes of pneumonia identified as Pneumocystis carinii, a parasitic protozoan bacteria, has been reclassified and identified as a fungi due to genomics was renamed last year (1999) as Pneumocystis jiroveci. For medical mycologists this was an interesting discovery and an important reclassification for treatment of pneumonia."

Yes, but what does that mean? "Good question, it answers what medical mycology and molecular medicine is all about. Simply fungi, plants bacteria and humans all have a different molecular and cellular makeup. Drugs are designed to target the difference in the cells, cell function, their internal organs and reproduction. There has been an increase in optimism for the health care profession because of this research and we now have pharmaceuticals designing their drugs to target these pathogens with more selectivity based upon a better understanding of those targets."

What do we know about mold, cancer and other fungal related diseases? "Relating to neoplasia (abnormal cell growth) , we know that mold produces many toxins and exposure to some molds result in a cancer or unnatural cell growth both hyperplasia and metaplasia. We know that the common skin mole is more closely associated to fungal M - O - L - D than to any M - O - L - E. That is why dermatologists tell humans to watch for any changes in their M O L E. Mold produces melanin to protect its DNA from UV radiation. The melanin, brown spots, remain after a benign fungal mole has died off or become dormant and other continue to grow into what becomes a malignancy.

I have investigated cases where initial diagnosis was cancer and later from biopsy and culture identified as a mycosis. Unfortunately there are not enough post mortem autopsies to determine the cause of death other than nebulous catch all clinical definitions as the cause such as "tumor" or "cancer". Macroscopy (low magnification) also fails in histopathology to adequately identify fungal pathogens."

"If you want to read something very interesting see Leyland H. Hartwell's * Noble Prize in Medicine Lecture delivered on December 9, 2001. In his opening speech he introduces the fact that in culture cancer cells just like fungal mold, often described by histopathologists as undifferentiated carcinomas, are immortal just like fungal mold in that they continue to grow even outside the body, when normal human cells do not. If cancer cells are not human cells, then what are they? Fungal mold? I'll email you a copy or provide a link " * download link

Are we making progress in diagnosis and treatment?

"Yes, yes. Progress on multiple fronts not just in research but also in diagnosis and treatment of  humans exposed and infected by fungi.  Working as a clinical researcher I have worked in cases with some America's leading scientists and medical researchers including Dr. Ritchie Shoemaker, MD (Maryland)developer of a protocol for diagnosis of fungal exposure and disease described in "Mold Warriors", Dr. Dennis Hooper, MD (Texas)and his pioneering assay methods for the detection of mycotoxin exposure and clinical research scientist for his work with mycoses, pathologist Dr. Michael Gray, MD (Arizona), allergist/immunologist Dr. Michael Rudenko, MD (UK) for his research with mold allergens and others in the EU."

"There are many new discoveries that scientists are just overwhelmed with their findings and conclusions. We are certainly living in very interesting times. In the past week a new book ("Cancer is a Fungus") was published written by the Roman Oncologist Dr. Tullio Simoncini, MD detailing what I and many researchers have known for years that fungi and mold are involved in nearly all cancers. Dr. Simoncini says that they are not just involved but are the cause of many if not nearly all conditions referred to as 'cancer'. The book clinically documents the 'cure' of many cancer patients some that were 'terminal'. The book is written for doctors and patients. His work is fully supported by the findings published in 'Fungalbionics' by the UN WHO's Director for the study of mycotoxins in food, Dr. Antonio Costantini, MD (California) now in Frieberg, Germany. In my opinion these doctors are truly heroes of medicine for our time."

A final question: What is happening in research?

As you know my current interest and studies in medical mycology is at the molecular level including the affect of fungal metabolites on metabolic pathways, mycotoxicity at many levels and related genomics directing the DNA lab of the Mycological Institute. Many interesting discoveries have been made. Much of the research is abstract and performed for research purposes, that which is of clinical interest we publish and present at scientific meetings and conferences.

A recent Japanese study proved to be interesting suggesting that mold toxins have the ability to signal the beta cells in the pancreas to shut themselves off in a cellular process called apoptosis or programmed cell death. These cells produce insulin. We may find a mycotoxin from a fungal mold or yeast that is causing this disease present in type one diabetics. Other research has discovered that some cells become immortal due to mycotoxins and resulting in neoplasia."

"In wrapping up with global research efforts in molecular medicine and medical mycology well under way we are clearly getting a better picture of fungi and their role in human health."

Very interesting. Thank you for your time. "Thank you for your interest."

For an earlier interview (2000) and more please see: What is Fungal Mold Mycology?

For a 2012 Interview see ISHAM Berlin

Questions for Dumanov may be directed to:

MEDICAL MYCOLOGIST

Last Updated: December 22, 2005

Copyright 2005-2006 Discovery Channel and NJIE

Discovery Channel Show - Is Your House Out to Get You? -   Toxic Mold  and other Dangers in the Home.

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