An effort over the past year by New York City Health Commissioner Thomas Frieden to align a New York state law with CDC’s revised recommendations on HIV testing in the U.S. has created a “sharp rift” between the medical community and HIV/AIDS advocates, the New York Times reports (Chan, New York Times, 12/25/06). CDC’s revised recommendations advise that HIV tests become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling be dropped. A New York state law passed in the 1980s requires a physician or anyone ordering an HIV test to have the individual receiving the test read and sign an informed-consent form. The form — which is separate from the general-consent form usually used to authorize a wide range of medical tests — explains the test and patients’ rights. The law also requires that before the form is signed, the care provider ordering the test must provide an “explanation of the nature of AIDS- and HIV-related illness, information about discrimination problems that disclosure of the test result could cause and legal protections against such discrimination, and information about behavior known to pose risks for transmission and contraction of HIV infection.” Under the law, if an individual tests positive, the person giving the test results is required to provide “counseling or referrals for counseling” on the emotional effects associated with an HIV diagnosis, possible discrimination, sexual behaviors and other areas. Frieden since December 2005 has attempted to change the state law (Kaiser Daily HIV/AIDS Report, 10/02/06). According to the Times, most of Frieden’s proposal is contained in a bill (A 11958) sponsored by state Assembly member Darryl Towns (D). After months of talks between city health officials and advocates, Frieden’s proposal was addressed on Wednesday at a state Assembly Health Committee hearing in New York City.

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“New York is an epicenter of this epidemic, and we’re very far from being an epicenter of care and control,” Frieden said last week, adding that if a written consent form is a noticeable obstacle to routine testing, it should be dropped. “Frankly, there are a lot of misconceptions about what’s being proposed, and, frankly, there are some who term themselves AIDS advocates who are very comfortable with the current situation,” he said. State Sen. Thomas Duane (D) said Frieden’s proposal is “well intentioned but grossly misguided,” adding that it fails to address “doctors’ discomfort with addressing HIV/AIDS.” State Assembly member Richard Gottfried (D), chair of the Assembly Health Committee, said, “I remain convinced that written consent is extremely important,” adding, “There may well be ways we can further simplify the counseling process.” Some attorneys at the hearing testified that written consent is the best way to confirm a client’s preferences for HIV testing. Marcelo Venegas-Pizarro — chief medical officer at the AIDS advocacy group Housing Works, which opposes Frieden’s proposal — said, “Pretest counseling and informed consent have forced me to take the time to ensure that a patient understands what is being done.” Some physicians and the Greater New York Hospital Association testified in support of Frieden’s proposal. A survey released this summer by the New York City Department of Health and Mental Hygiene of 137 primary care doctors in South Bronx, Central Brooklyn, East Harlem and Central Harlem found that 38% answered yes when asked, “If written consent were no longer required, would you offer more patients an HIV test?” The administration of Gov. George Pataki (R) has not supported Frieden’s proposal, and it is unclear whether Gov.-elect Eliot Spitzer (D) will back it, the Times reports (New York Times, 12/25/06).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Andy Irons (July 24,1978 – November 2, 2010) died yesterday en-route from Puerto Rico to Kauai where he lived, probably from complications due to dengue fever, according to the Association of Surfing Professionals. Irons won the world surfing championship three times at every location on the elite men’s professional circuit.

Dengue fever, otherwise known as breakbone fever is an infection carried by the Aedes aegypti mosquito, and more rarely by the Aedes albopictus mosquito, that causes flu-like symptoms. Dengue fever can be caused by four different viruses. In most cases Dengue symptoms are mild, but they can be severe, examples include dengue shock syndrome and DHF (dengue hemorrhagic fever). The majority of patients who develop more serious forms of the infection need to be admitted to hospital. Currently, there are no vaccines to prevent Dengue fever. Prevention is best achieved by avoiding the mosquito bite.

According to the World Health Organization, up to 100 million people develop dengue fever globally each year. It is more common in tropical areas and urban parts of the subtropics. Unlike malaria, dengue is equally prevalent in urban and rural areas.

Andy Irons’ family issued the following message:

The world of surfing mourns an incredibly sad loss today with the news that Hawaii’s Andy Irons has died. Andy was a beloved husband, and a true champion.

Irons, 32, withdrew from a professional surfing event in Puerto Rico last weekend due to illness, and passed away during a layover en-route to his home in Kauai, Hawaii. He had reportedly been battling with Dengue Fever, a viral disease.

At this time the family thanks his friends and fans for their support, and asks that the community respect its privacy. The family also asks to not be contacted so their focus can remain on one another during this time of profound loss.

Irons, who began his career with the elite ASP World Tour in 1998, went on to collect 20 elite tour victories, four Triple Crown of Surfing Titles, three consecutive ASP World Titles and change the sport forever with his unparalleled ability and comprehensive approach to surfing.

Fellow competitors said Irons had been struggling with dengue fever ever since becoming infected in Bali, Indonesia.

Source: Association of Surfing Professionals

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Catching the flu is never fun, but your circle of friends or social networks may help predict just when and where you will contract the virus. This method has been dubbed the “friendship paradox” and was formulated by Nicholas Christakis, professor of medicine, medical sociology and sociology at Harvard University, and James Fowler, professor of medical genetics and political science at the University of California, San Diego. So what is this “friendship paradox,” and how does it apply to influenza?

In 1991, the “friendship paradox” was born. It states that the friends of any single person are more popular than themselves. Hard pill to swallow? Well for example, take a classroom of high school students and ask each of them to name one friend. On a calculated average, the named friends of friends will live higher in the social network chain than the persons that originally named them.

Okay, okay. Still having trouble grasping the concept? Imagine a highly publicized art gallery opening in New York City with the guest of honor the focus of attention at the center of the hall. On the outskirts, a few purists lean against the walls staring at their drinks wearing glasses and bowties. You walk around and ask the invitees to each name a friend, and the results will weigh heavily in the direction of the well-connected artist. Few people will name one of the wall supporting bystanders at the gala.

The persons at the center of a social network are exposed to diseases earlier than those at the margins states the paradox. Again, your friends are probably more popular than you are, and this “friendship paradox” may help predict the spread of infectious disease. However, Christakis and Fowler found that analyzing a social network and monitoring the health of members is an optimal way to predict a wave of influenza, detailed information simply doesn’t exist for most social groups, and producing it is time-consuming and expensive.

In 2009 though, the authors of this research used the theory to analyze the 2009 flu epidemic in 744 students at Harvard University. They first reached out to 319 students who then named 425 additional friends. The friends of students, the 425, exemplified flu symptoms two weeks before the original group of 319 using one method of detection from self-reporting and data from Harvard University Health Services. In addition the “friends” group showed flu signs a full 46 days prior to the epidemic’s peak.

Christakis states:

We think this may have significant implications for public health. Public health officials often track epidemics by following random samples of people or monitoring people after they get sick. But that approach only provides a snapshot of what’s currently happening. By simply asking members of the random group to name friends, and then tracking and comparing both groups, we can predict epidemics before they strike the population at large. This would allow an earlier, more vigorous, and more effective response.

Fowler continues:

If you want a crystal ball for finding out which parts of the country are going to get the flu first, then this may be the most effective method we have now. Currently used methods are based on statistics that lag the real world – or, at best, are contemporaneous with it. We show a way you can get ahead of an epidemic of flu, or potentially anything else that spreads in networks.

Both Christakis and Fowler also think that this “friendship paradox” can be utilized across the board and foresee the spread of other diseases or even drug usage, much like social networks today spread fashion trends and gossip.

Like a third opinion? John Glasser, who was not directly involved in this study and a mathematical epidemiologist at the Centers for Disease Control in Atlanta said:

Christakis’ and Fowler’s provocative study should cause infectious disease epidemiologists and public health practitioners alike to consider the social contexts within which pathogens are transmitted. This study may be unique in demonstrating that social position affects one’s risk of acquiring disease. Consequently, epidemiologists and social scientists are modeling networks to evaluate novel disease surveillance and infection control strategies.

Christakis N, Fowler JH (2010)
“Social Network Sensors for Early Detection of Contagious Outbreaks”
PLoS ONE 5(9): e12948. doi:10.1371/journal.pone.0012948

: Sy Kraft, B.A. – Journalism – California State University, Northridge (CSUN)

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Australian Prime Minister John Howard on Friday said he is preparing a plan that would tighten regulations concerning HIV-positive immigrants seeking to enter the country, the West Australian reports. The plan could prevent HIV-positive people from entering Australia or track their movements throughout the country, according to the Australian (King, West Australian, 5/12). Howard last month in a radio interview said his “initial reaction is no” to a question of whether HIV-positive people should be permitted to immigrate to the country, although he said he needed “more counsel” on the issue. He said, “I think we should have the most stringent possible conditions in relation to that nationwide, and I know the health minister is concerned about that and is examining ways of tightening things up.”

According to Howard, Australia currently restricts those with certain communicable diseases, such as tuberculosis, from immigrating. Australia’s policy says people ages 15 and older who apply for a permanent visa must receive an HIV test. If applicants are found to be HIV-positive, “immigration authorities are to take into consideration the cost of the condition to Australia’s health care and community services if a visa were to be granted.” Seventy of the 334 new HIV cases reported in 2006 in the Australian state Victoria were among immigrants who were HIV-positive when they came to the country (Kaiser Daily HIV/AIDS Report, 4/13).

Howard recently wrote letters to the country’s ministers of immigration and health asking about the public health implications of letting HIV-positive people immigrate to the country, The Age reports. The Department of Immigration and Citizenship is “looking at what requirements” for HIV testing Australia has “under different visa classes” and whether requirements for HIV-positive people to enter the country should be expanded, a spokesperson for Immigration Minister Kevin Andrews said. According to The Age, the immigration and health departments are investigating whether the government should be notified of HIV-positive immigrants’ movement throughout the country. An unnamed source said that the departments are not considering a ban on HIV-positive people entering the country but are seeking improved screening and monitoring (Stafford, The Age, 5/11). According to the Australian, Howard expects to discuss the issue with his Cabinet within the next two weeks.

Reaction
Trish Langdon, executive director of the Western Australian AIDS Council, said that Howard misunderstood the regulations for HIV-positive immigrants, adding that HIV-positive people seeking admission to the country or citizenship “usually [have] a very compelling reason” (West Australian, 5/12). Don Baxter, spokesperson for the Australian Federation of AIDS Organizations, said that HIV cases “arising from short-term visa holders have had a minuscule impact” on the HIV/AIDS situation in the country. Baxter added that screening people who are seeking to enter Australia could have an adverse impact on the tourism industry (The Age, 5/11).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Women in the U.S. and South Africa are sending breast milk to children at the iThemba Lethu orphanage in Durban, South Africa, whose mothers have died of AIDS-related illnesses, ABCNews’ “World News Tonight” reports. According to ABCNews, the mothers of approximately three million children ages five and younger in sub-Saharan Africa have died of AIDS-related illnesses. Perry Reimers, who runs the breast milk bank at the orphanage, said the nutrition and immune properties in breast milk are “absolutely vital” for the orphans, many of whom are immuno-compromised or HIV-positive. Missouri resident Jill Youse discovered the iThemba Lethu orphanage online and founded the International Breast Milk Project to collect breast milk from U.S. women and deliver it to South Africa. “For children who are sick, especially if they have HIV or other diseases, breast milk could be the difference between life and death,” Youse said. All donors in the U.S. and South Africa are screened and their milk is pasteurized before it is given to the orphans (Seemunghal, “World News Tonight,” ABCNews, 10/4).

The complete transcript of the segment is available online. Video of the segment is available online.

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

The U. S. Department of
Health and Human Services (HHS) and its Centers for Disease Control and
Prevention (CDC) will launch National Infant Immunization Week (NIIW) with
events April 21-28, 2007. Hundreds of communities throughout the United
States are expected to participate in NIIW by sponsoring activities
emphasizing the importance of timely infant and childhood vaccination.

CDC and HHS will collaborate with state and local health departments,
the United States-Mexico Border Health Commission, and the Pan American
Health Organization (PAHO) on NIIW events across the United States,
including events in Nevada; Colorado; Hidalgo County, Texas, and
communities along the United States-Mexico border to promote and provide
infant vaccinations.

NIIW’s continuing theme is “Love them. Protect them. Immunize them.”

“We can now protect more children from more vaccine-preventable
diseases than ever before,” said Dr. Anne Schuchat, Director of the CDC’s
National Center for Infectious and Respiratory Diseases. “Millions of
children have been vaccinated, and millions of cases of disease, disability
and death have been prevented.”

Every day, 11,000 babies are born in the United States who will need to
be immunized against 14 diseases before age two. Despite recent gains in
infant immunization coverage, more than 20 percent of the nation’s
two-year-olds are still not fully immunized against infectious diseases to
which they are especially vulnerable.

“The suffering or death from a vaccine-preventable disease is an
unnecessary human tragedy,” said Dr. Schuchat. “Let us renew our efforts to
ensure that no child, adolescent or adult will needlessly suffer from a
vaccine-preventable disease.”

CDC has English and Spanish-language public education campaign
materials available to communities, including television public service
announcements, posters, print advertisements, matte articles, and
educational materials for parents and providers. Additional information
about NIIW-VWA and childhood vaccination is available from CDC’s National
Center for Immunization and Respiratory Diseases at
cdc/nip/events/niiw/default.htm. Information on VWA is
available at paho/English/DD/PIN/vw_2007.htm.

The Department of Health and Human Services’ mission is to protect
health and give a special helping hand to those who need assistance. The
Centers for Disease Control and Prevention protects people’s health and
safety by preventing and controlling diseases and injuries; enhances health
decisions by providing creditable information on critical health issues;
and promotes healthy living through strong partnerships with local,
national, and international organizations. For more information please
visit cdc/nip

U. S. Department of Health and Human Services; Centers for Disease
cdc/nip/events/niiw/default.htm Continue reading →

Needle-exchange programs are not widely available in most of Ireland, which could be increasing the risk of HIV and other infectious diseases among injection drug users, according to a government-appointed report recently released by the National Advisory Committee on Drugs and the National Drugs Strategy Team, the Irish Examiner reports. The report found that six out of 10 regional drug task forces do not provide needle-exchange services but have IDUs living in the area. In addition, task forces that do provide needle-exchange services — primarily located in the capital of Dublin and on the east coast — often do not make the services available on a 24-hour basis or on weekends. According to the report, the “review of the current provision of needle exchange clearly highlights the fact that, despite the identification of service needs and the inclusion of specific actions in the (National Drugs Strategy) on development of services, provision is still largely concentrated in local drug task force areas with inadequate coverage at a national level despite the evidence of drug misuse throughout Ireland.”

The report recommended that needle-exchange programs be established in all regional task forces; vending machines be piloted in inner-city Dublin to ensure 24-hour access to needle exchanges; programs provide devices such as pipes to prevent some users from progressing to injections; and prisons introduce the service in a way that does not compromise security. According to the report, the recommendations are part of an effort to curb the spread of bloodborne diseases such as HIV and hepatitis C in Ireland (Irish Examiner, 2/2).

The report is available online.

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Rev. Rick Warren on Wednesday at the XVI International AIDS Conference in Toronto announced that they will be partnering to increase funding for faith-based groups in Warren’s global church network, USA Today reports. Warren — a best-selling author and founding pastor of the Saddleback Church in Lake Forest, Calif. — oversees a network of 400,000 churches of various denominations that have common social concerns. Feachem said that although the Global Fund has sought to provide more grants to faith-based groups, it has received few applications from such groups, USA Today reports. According to Feachem, the Churches Health Association of Zambia, or CHAZ, is one example of an effective partnership between the Global Fund and faith-based groups. The Global Fund has provided $145 million to CHAZ, which coordinates the efforts of Christian, Muslim and Bahai groups that provide HIV/AIDS, TB and malaria services in the country. CHAZ Director Simon Mphuka said the Global Fund successfully works with churches in the country, which provide 60% of the rural medical care in Zambia. Warren said he became involved in HIV/AIDS prevention work four years ago, and his church has begun working in Rwanda to fight poverty, disease and corruption. “The church is the biggest network in the world,” Warren said, adding, “I can bring you to 10 million villages in the world that don’t have a doctor, don’t have a post office; they have nothing but a church. But it’s already on the ground, and we don’t have to hire staff.” Mphuka said that some groups “spoil the good work that they do” because they advocate an abstinence-until-marriage HIV prevention method. Warren said he believes the only way to curb the spread of HIV is to “save sex for marriage” and encourage men to respect women. “Everyone knows this is a women’s pandemic driven by behavior in men,” Warren said, adding that he will not dictate his beliefs to others. “Let’s everyone do what they can do,” he said (Sternberg, USA Today, 8/17).

Kaisernetwork is serving as the official webcaster of the conference. View the guide to coverage and all webcasts, interviews and a daily video round up of conference highlights at kaisernetwork/aids2006.

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

The first annual World Meningitis Day begins April 25, 2009 and is gaining national support. The day is meant to raise awareness and educate Americans about the dangers of contracting the Meningococcal disease. “We recognize the dangers of meningitis and the importance of being vaccinated against the disease,” said Fran Lessans, CEO of Passport Health, the largest provider of travel medical services and immunizations in the U.S. “Passport Health wants to honor this day and show its support by offering to vaccinate and educate Americans about the disease.”

Travel season is quickly approaching and travelers should be aware that many popular travel destinations are in countries where meningitis is endemic. International travel and migration facilitate the rapid intercontinental spread of meningococcal disease, according to The Journal of Travel Medicine. “The disease is endemic in the meningococcal belt which runs through sub-Saharan Africa,” added Lessans. “This area stretches from Senegal to Ethiopia across the middle of the continent.”

The meningitis vaccine is especially recommended, if not required, for the following people: students attending college/universities, students studying abroad, travelers, camp attendees, humanitarian workers, missionary workers, and volunteer abroad workers.

According to the World Health Organization (WHO), there is an estimated total population of 300 million people living in along this belt. You can find more information related to the meningococcal belt in Passport Health’s “country of the month” blog. In honor of Meningitis Day, the daily blog will focus on meningitis and how it can affect travelers.

Meningitis is a serious disease that affects the brain and spinal cord. According to the Centers for Disease Control and Prevention (CDC), approximately 20% of those infected have long term consequences and between 10%-12% die from the disease each year. The United States has nearly 3,000 cases of the disease every year. The disease is transferred through respiratory secretions and the spread of the disease is facilitated through prolonged contact. Be aware that meningitis can be contracted by people of all ages, not just college-bound students.

For more information about meningitis or Passport Health, click here or call 1-888-499-PASS(7277) to make an appointment.

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UCSF researchers have identified a new potential drug target for the herpes virus that causes Kaposi’s sarcoma, re-opening the possibility of using the class of drugs called protease inhibitors against the full herpes family of viruses, which for 20 years has been deemed too difficult to attain.

The new drug target, which is known as a protease dimer, could serve as a model for developing new therapeutics for diseases ranging from cancer to Alzheimer’s, the researchers say. Findings are reported in the Advance Online Publication section of the Nature Chemical Biology web site and can be found at nature/nchembio/index.html.

Most current antiviral drugs target the active sites of viral proteins, where enzymes and receptors work in a lock-and-key approach to either activate or deactivate that particular protein, the researchers explained. Traditionally, drug development has focused on inhibiting that lock-and-key action to prevent the enzyme, or receptor from being effective.

Some viral enzymes known as proteases, however, including those for HIV and the herpes virus family, take the form of a dimer, or two identical halves – much like a fully opened clamshell – in their most stable state. Those proteases play an essential role in making the virus infectious, but require the two clamshell halves to bind together to be activated, according to the paper.

The HIV protease was successfully targeted for drug development in the 1980s, by blocking the active site on the surface of the dimer, but the herpes virus protease dimer has consistently eluded efforts to disrupt it at its active site, the researchers said.

The UCSF team set out to find ways to instead prevent the two halves of the dimer from connecting at that clamshell joint, to prevent it from activating. What they found was a new target on the unstable, monomer form of the protease, which responded well to a chemical inhibitor.

“If you disrupt the protein-protein interactions, you don’t need the key to a specific lock,” said Charles S. Craik, PhD, senior author on the paper and a professor of pharmaceutical chemistry in the UCSF School of Pharmacy. “Instead, we’re essentially preventing the lock from being made in the first place.”

Craik, who also led a team that identified HIV protease inhibitors in the late 1980s, said the Nature Chemical Biology paper validates this new site as a viable option for small-molecule drugs to treat Kaposi’s, as well as other members of this viral family.

“All known herpes virus proteases are structurally similar,” Craik explained. “The inhibitor we found knocks out not only KS, but also the cytomegalovirus protease, so the site we’ve identified here could be a target for a broad-acting inhibitor against the entire viral family.”

To their knowledge, the researchers said, this is the first small-molecule inhibitor of a herpes virus protease to not only act outside the active site, but also to select for the partially unfolded protein to keep it from forming the dimer interface.

Herpes viruses make up one of the most prevalent viral families, including eight human viruses that cause a variety of devastating illnesses, the researchers said. Those include mononucleosis (Epstein-Barr virus), shingles (Varicella zoster virus), genital herpes (herpes simplex), retinitis (cytomegalovirus) and cancer (Kaposi’s sarcoma). While therapies exist for these viruses, they often have negative side effects and are facing rising viral resistance.

In addition to validating herpes virus proteases as suitable targets, Craik said this research was also among the first to use computational design to identify and create a potential drug to target that protease interface.

Using high-throughput screening, the team screened a library of 182 compounds that it had specifically and rationally designed to mimic the protease interface. The work identified six molecules that inhibited the Kaposi’s sarcoma virus protease activity by at least 50 percent, including one that was highly potent.

That discovery potentially opens myriad opportunities for drug discovery, Craik said, by making target receptors that were biologically validated, but then deemed undruggable, more attractive. Protein-protein interactions have been researched as drug targets against a range of diseases, from certain cancers to neurodegenerative diseases. This advance could enable researchers to reconsider those targets, he said.

The lead investigator on the paper was Tina Shahian, with the Graduate Group in Biochemistry and Molecular Biology at UCSF. Co-authors were Gregory M. Lee and Ana Lazic, both in the UCSF Department of Pharmaceutical Chemistry; and Leggy A. Arnold, Priya Velusamy, Christina M. Roels and R. Kiplin Guy, all with the Department of Chemical Biology and Therapeutics at St. Jude Children’s Research Hospital, Memphis, TN.

The CMV protease expression plasmid for this work was provided by Wade Gibson, a professor in the Department of Pharmacology and Molecular Sciences at Johns Hopkins School of Medicine. The work was funded by grants from the National Institutes of Health, the American Lebanese and Syrian Associated Charities and St. Jude Children’s Research Hospital.

The authors declare no conflict of interest in this paper.

Source:
Kristen Bole

University of California – San Francisco Continue reading →