Thứ Hai, 30 tháng 9, 2019
NPR News: Just A Handful Of Nuts May Help Keep Us From Packing On The Pounds As We Age
U.S. adults put on about a pound a year on average. But people who had a regular nut-snacking habit put on less weight and had a lower risk of becoming obese over time, a new study finds.
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[Discussion] Viability of Subscription payment model or "Netflix-Style" Drug pricing
I've attached the link. I'm curious to understand why pharmaceutical companies would agree to such an arrangement? If anything they would have to produce more drugs for the same payments from the state. Exactly how would they profit?
Comment [discussion]: man got priced out of basic care, had stroke and is spending the rest of his life on public healthcare + assistance. What should he have done differently?
Go to store for affordable pure essential oils?
Hi there! New to the group so this may have been discussed, but I was hoping to get some wisdom regarding the purchase of affordable natural essential oils? I’ve been making my family’s body care products and cleaning supplies for about 3 years so I’m still somewhat new, but fully committed! I’ve used EO’s throughout but I’ve never really been married to a particular brand, retailer or philosophy that helps manage my spending in that area. I often shop at natural food stores so I’ll happen upon a sale or special and grab a few, but otherwise, I’ll buy full price — usually a 2 - 4 Oz size at most — I feel like there are some great deals out there that I’m missing out on! Yearly sales, memberships, particular retailers — if mentioning names is allowed, again, new to the rules and not trying to advertise anything — I’m open to all of the guidance I can get!
While I don’t need a huge supply, I’m open to buying bulk if that’s the way to do it. I’m also open to making my own if that is more cost effective and somewhat manageable without a distiller). Thanks in advance for your feedback!
[Question - Other] Sources to understand and compare healthcare systems
I'm looking for Anu Partanen's The Nordic Theory of Everything but for other countries. What books or other sources would you suggest?
There's plenty of academic information comparing healthcare systems, but I'm hoping to find other sources that combine the technical information with lived experience like Partanen does.
I'm researching family caregiving (unpaid care for people with chronic illness, terminal illness, or disabilities), which falls mostly outside of the formal healthcare system in the US, so lots of sources discussing healthcare mention it in passing or leave it out entirely.
What are the benefits of having white teeth?
I posted here because I consider teeth as part of natural beauty.
In your opinion, should NPs continue to have their scope of practice and independence expanded? [question - other]
NPR News: Elon Musk Unveils SpaceX's New Starship, Designed To Fly To The Moon, Mars And Beyond
Calling it "the most inspiring thing I've ever seen," the SpaceX CEO talked up his company's big innovation and plans to fast-track production of the rocket. He hopes to fly passengers by next year.
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Chủ Nhật, 29 tháng 9, 2019
Living in very humid places
I just moved to an island, which is great, except my skin is getting dry and poofy, and my skin clogged.
I have no idea where to begin basically...
I currently wash my hair occasionally with a almond/henna shampoo and use a hair mask sometimes, and when it feels dry I use argan oil on it...
For my skin I have no idea how to moisturize. I tried oil cleansing a few years ago but then I moved to Thailand and my skin did not like it here at all. So I stopped that and now I just use a regular cleanser from 7/11...
NPR News: UCLA Opens World's 1st Institute To Study Kindness
NPR's Michel Martin speaks with anthropology professor Daniel Fessler about UCLA's new Bedari Kindness Institute.
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[Question - Other] Excessive Yawning/Upper Back Related?
I have had this need to yawn for maybe the past 2-3 years and it’s really been annoying. I’ve seen don’t have caffeine or exercise regularly, I’ve tried those and I’m still here yawning or having to take a deep breath every 30 seconds to a minute. Also whenever I go to maybe “crack” my back or stretch, I find it easier to get it out until it come back. Is that related to why I have this deep breath problem and is there anything I can possibly do to “stop yawning” every so often?
Thứ Bảy, 28 tháng 9, 2019
[discussion] Even economists confused why US healthcare is so expensive
Using Vanilla Extract in Lip Balms?
Hey! I've just recieved my first lot of ingredients to start making my own cosmetics for personal use! I thought I'd start off with something easy, lip balm, but I was concerned about the content of alcohol in Vanilla Extract?
It's not just the taste of vanilla I want, but the benefits of the natural vanilla. I was worried because of the alcohol, it would lead to drying out my lips, not mixing well with the other ingredients. Is vanilla powder a suitable alternative?
Any advice is appreciated, sorry I'm a massive noob with all this! Thank you!
NPR News: The Health Benefits At The Center Of The United Auto Workers Strike
A key issue in the contract dispute between General Motors and the United Auto Workers is health benefits. Workers have had famously great health plans, paying just 3% of costs.
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NPR News: U.S. Justice Department Charges 35 People In Fraudulent Genetic Testing Scheme
Doctors, labworkers and telemarketers from around the U.S. were among those arrested in the investigation of a scheme that the DOJ alleges defrauded seniors and Medicare.
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Prof shared this, I need help sourcing it... [Question - Other]
I have seen this information from another presentation from my Healthcare internship awhile back. Its really interesting with fascinating ramifications. Kaiser Family Foundation puts out a lot of content and google can't do it all! Thanks everyone!
NPR News: CDC Zeroing In On THC-Based Vaping Products As A Major Source Of Lung Injuries
Health officials say people with vaping-related illness have used more than 200 products sold under 87 brands. That's complicating efforts to identify the substances contributing to lung damage.
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NPR News: Justice Department Charges 35 People With Defrauding Medicare Of More Than $2 Billion
The Justice Department has charged 35 individuals with defrauding Medicare of more than $2 billion. The scheme allegedly involved bribes and kickbacks for genetic tests to predict cancer.
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Thứ Sáu, 27 tháng 9, 2019
[News] Kaspersky raises alarm over increasing targeted attacks against pharmaceuticals
NPR News: Journalists File Lawsuit To Force Feds To Release Medicare Advantage Audits
A lawsuit filed by Kaiser Health News under the Freedom of Information Act could spur the Centers for Medicare & Medicaid Services to release audits that document up to $650 million in overcharges.
Read more on NPR
Launch of Amazon's Telemedicine Service Has Teladoc Investors Sweating [News]
Pfizer Introduces Robot to Better Analyze Patient Responses [News]
[Discussion] Medicare-for-All Is Flawed, But Employer-Based Healthcare Is Bad Too
NPR News: A Peculiar Solar System Has Scientists Rethinking Theories Of How Planets Form
A surprisingly large planet orbiting a small star defies the conventional wisdom about how planets are born. But a dark-horse idea from more than 20 years ago could explain it.
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Thứ Năm, 26 tháng 9, 2019
[DISCUSSION] Hi I’m Annabelle Timsit, a Quartz journalist who uncovered how the US opioid marketing playbook is going global after investigating Mundipharma, the international arm of US-based Purdue Pharma. Ask me anything!
NPR News: Too Much Training Can Tax Athletes' Brains
Research finds that triathletes who train too hard can impair a brain area involved in achieving goals like winning a race. Fatigued athletes choose immediate gratification over long-term rewards.
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[Question - Insurance] Just Turned 26... Insurance Question.
I am an accountant and I just got kicked off of my Aetna insurance that I had through my parents' navy coverage. I am now receiving what i have discovered is bottom-tier coverage through Kaiser and by default, Delta (now Dominion or something). dental insurance.
I have no problem thus far with the Kaiser health insurance, but the dental fucking blows. I went to urgent care this past Saturday because a cavity became infected and was spreading to my neck and face--- they told me to schedule an appointment with the dentist as soon as possible. I tried to call them both yesterday and today and sat on hold for an hour or more each day before being hung up on. I have read online that the only dentists I will be qualified to see all have poor reviews anyway. I called up Kaiser and asked if there was any way for me to pay to sign up for better dental insurance where I can actually call a number and schedule an appointment, but they said I am covered and that I needed to call the same number that just put me on hold for an hour before hanging up on me.
What the heck can I do? I have bad teeth genes from my mom who is always getting some sort of dental work done and I need better dental care. I am willing to pay more for the convenience of being able to call a number and actually have them answer without making me wait. What are my options? I know absolutely nothing about health insurance.
Is it worth going to medical school if your end goal is primary care nowadays?[other]
As opposed to NP or PA?
My body butter won’t thicken?
I’ve been making whipped body butters for a while now and they usually turn out nice no matter what recipe I use. I wanted to add beeswax and arrowroot powder this time to reduce greasiness and to thicken it up a little. I used a recipe I’ve used before, 1/4c Shea, 1/4c cocoa butter, 1/4c coconut oil, and 1/4 sweet almond. Then I added a teaspoon of beeswax and a teaspoon of arrowroot. This was my first time added beeswax and arrowroot and I only added a small amount just to test the texture. I’m concerned that maybe I had the heat too high when melting my butters together? I was smelling an odd kind of burnt smell throughout the house and now my body butter won’t whip and it’s more of a lotion texture. Any advice? Should I melt it down again and add more cocoa or Shea to stiffen it up?
NPR News: No Plan B: Deciding Not To Have Children Because of Climate Change
Faced with the prospect of severe climate disruptions, potential parents are rethinking that choice.
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NPR News: Prehistoric Babies Drank Animal Milk From A Bottle
The remnants of ruminant milk were found in tiny vessels buried with infants thousands of years ago. Scientists say the ancient "baby bottles" were sometimes shaped like "mythical animals."
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Thứ Tư, 25 tháng 9, 2019
[News] Meet The Health Officials Who Alerted The World To The Alarming Vaping Illness
NPR News: MacArthur 'Genius' Grant Winners Attest To 'Power Of Individual Creativity'
As usual, the more than two dozen winners in 2019 span a range of fields, from fiction and cartoons to neuroscience and theoretical geophysics. Now they've got one important accolade in common.
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NPR News: Earth's Oceans Are Getting Hotter And Higher, And It's Accelerating
The U.N. Intergovernmental Panel on Climate Change has released its latest report on the oceans, and it's not good. The report also notes a relatively new phenomenon in the oceans: marine heat waves.
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[Discussion] Nutrition intervention effective with IBD
[Discussion] Rampant discrimination at Public Health Facilities- Aarti's story
NPR News: If E-Cigs Were Romaine Lettuce, They'd Be Off The Shelf, Vaper's Mom Tells Congress
As numbers of vaping-related lung disease rise, a mom testifying before Congress compared the illness to a food poisoning outbreak and called on lawmakers to address the epidemic of teen vaping.
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[News] 76% medical devices of healthcare facilities in Philippines may be infected by malicious code
How does Universal Healthcare affect ambulatory vs acute care? [Discussion]
Hey everyone. Pretty basic question here... those who live in countries that have Universal Healthcare, how does that affect where your patients go? Do you see more of a shift toward outpatient/ambulatory care for personalized care? Or do people tend to go to ED/hospitals for ease of access? And do these systems have specific protocols in place to steer patients toward ambulatory care where the cost is cheaper per capita for the system?
Does every doctorate level career have to come with a mountain of debt nowadays? [question-other]
[News] How expanding health savings accounts could cure America’s sick health care system
A Look Into Health IT and Patient Safety [Discussion]
NPR News: Status Of Health Benefits Remains Unclear As United Auto Workers' Strike Continues
While the United Auto Workers strike continues, General Motors and the union are telling different stories about what's going on with the health benefits of striking workers and their families.
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Heart Surgery Solutions? [Question - Insurance]
Hey guys. I have a heart condition that while not fatal, is negatively affecting me and I'd really like to be rid of it. It's very fixable with a minimally invasive heart surgery, so I've been considering that. Is there no way for me as a very low income young person, to get this surgery without taking on a massive debt? I dont have a "career" tier job yet, and the health insurance I'd be getting through them is horrible. I just feel like I have no solutions unless I completely go through college, get a career, and get insurance through them
NPR News: Trump Administration Escalates Battle Over Environmental Regulations With California
The Trump administration threatens to cut federal highway dollars for California over air pollution.
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NPR News: No Plan B: Youth Leading The Charge On Climate
Young people are taking center stage in the fight against climate change.
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Thứ Ba, 24 tháng 9, 2019
[discussion]
[Question - Insurance]
My wife was out of work for 13 weeks due to mental illness. For 12 weeks, we were covered by her existing employers health care coverage (Cigna). Cobra insurance was offered to us through her employer for the 13th week where we wouldn't have coverage. My wife is now back to work and her prior health coverage has resumed. Her employer is saying that we must purchase Cobra for the 13th week although we are already covered once again with Cigna. Is this a requirement for us? The cost of Cobra is $1750 which my wife is being garnished for (3 months) since her employer is paying for it, and we must reimburse the company. I guess my question is: If we didn't use any medical services for the 13th week (Unsure yet if we did or didn't) why would we be required to purchase this coverage? I assume that if we used services during that 13th week and the cost exceeds $1750, Cobra would be the better option. However her employer is saying it has to be purchased either way. Does anyone know about this stuff that may be able to explain to us?
NPR News: As Made-To-Order DNA Gets Cheaper, Keeping It Out Of The Wrong Hands Gets Harder
Labs are churning out more and more synthetic DNA for scientists who want to use it to reprogram cells. Some say the technology has outpaced government safety guidelines put in place a decade ago.
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[News] Unhealthy Food Causes 1 in 5 Deaths
NPR News: Doctors Without Borders Calls For More Transparency In Distribution Of Ebola Vaccine
The international humanitarian group says the World Health Organization is restricting access to the vaccine in the Democratic Republic of Congo, where the current outbreak has killed more than 2,100.
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NPR News: No Plan B: The Climate-Conscious Voter
As temperatures rise, voters are making the climate a central issue in this presidential campaign.
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Thứ Hai, 23 tháng 9, 2019
NPR News: U.N. Climate Summit Sets Stage For New National Emissions Promises
Humanity is not on track to avoid the most catastrophic impacts of climate change. Delegations from nearly 200 countries are meeting to discuss promises they made to reduce greenhouse gas emissions.
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NPR News: Exercising To Ease Pain: Taking Brisk Walks Can Help
Never mind a runner's high — the buzz some people say they get after a run. Neuroscientist Benedict Kolber was more interested in how to generate pain relief via a brisk walk. It can really work.
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[discussion] is it legal to fire someone for having surgery?
NPR News: What To Expect From The U.N. Climate Action Summit
World leaders are meeting in New York on Monday amid growing fear that promises countries have made to reduce emissions are insufficient to avoid the most catastrophic effects of climate change.
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NPR News: VIDEO: Tree Scientist Inspires Next Generation ... Through Barbie
Nalini Nadkarni was one of the first people to study the canopy — the part of trees just above the forest floor to the top branches. Her discoveries have helped shape our understanding of forests.
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[Discussion] Healthcare's Distortion of the US Economy
Chủ Nhật, 22 tháng 9, 2019
[News] Millions of Americans’ Medical Images and Data Are Available on the Internet. Anyone Can Take a Peek.
NPR News: Ahead Of Climate Summit, 2 Views From Cities In Canada And India
NPR's Melissa Block speaks with two U.N. Climate Change Summit attendees: Lisa Helps and Minal Pathak. The summit begins Monday.
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Going into a program for a few months cant take anything with alcohol in it...
So here's the deal I dye my hear. Yes, yes bad but yanno I'm vain. Anyways I'm looking for any tips for natural hairspray products that are sold (I'm not crafty), Natural based dry shampoo, and shampoo/conditioner that don't include sulfate.
[Question - Other] How to fight illness in one day?
Thứ Bảy, 21 tháng 9, 2019
Any good natural beauty YouTube channels
I’m stuck in YouTube’s algorithm so the only one I know of is cholistichabits, any other ones I should know about?
Natural bug repellent?
I'm one of these people that gets bitten to death by mosquitos when I go on holiday and was wondering if anyone has tried any natural bug repellents that worked? Or even if you made your own? I don't want to use popular sprays, etc, due to the toxicity of them to both the user and the planet.
Dark circles
Hey guys!
Has anyone had any success with almond oil diminishing dark circles? I only wear concealer to cover my dark circles up, if I brightened the area I'd happily go make up free :)
NPR News: EPA Administrator Weighs In On California Emissions Decision
NPR's Audie Cornish speaks with EPA Administrator Andrew Wheeler about the administration's plans to revoke California's authority to set its own vehicle emissions standards.
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Thứ Sáu, 20 tháng 9, 2019
NPR News: A New Way Of Paying For Maternity Care Aims To Reduce C-Sections
Instead of paying doctors piecemeal for prenatal appointments and delivery of the baby, some insurers now offer medical practices one lump sum to cover it all.
Read more on NPR
NPR News: A New Way Of Paying For Maternity Care Aims To Reduce C-Sections
Instead of paying doctors piecemeal for prenatal appointments and delivery of the baby, some insurers now offer medical practices one lump sum to cover it all.
Read more on NPR
[Discussion] Tips for a Healthy Body and Mind
[News] Strongest evidence for carbohydrate-restricted diet in diabetes. (ADA)
[Discussion] Pelosi Unveils Plan to Lower Prescription Drug Prices
NPR News: Global Youth Climate Strike Expected To Draw Large Crowds
Strike organizers are calling on their fellow young people to skip school Friday and rally to demand greater action against climate change.
Read more on NPR
NPR News: To Better Understand The Arctic, This Ship Will Spend A Year Frozen Into The Ice
A group of scientists is embarking on a bold plan to better understand an extremely understudied part of the rapidly warming Arctic — the central Arctic Ocean.
Read more on NPR
I'm self conscious about my underarm hair when I'm super dressed up...
Is there a way maybe style it idk... My mom keeps putting me down for it and I'm wearing a sleevless dress to a dinner with her on Saturday (for my 19th birthday)... Just any tips to feel more confident/ make it feel still fancy and nice any help much appreciated!
[Question - Insurance]
Does anyone have the NYS Empire Plan that includes United Healthcare? If so, could your please help me understand the co-pays? I may need a diagnostic colonoscopy. Would this be just the outpatient surgery copay or would I have to meet my deductible first? Tried calling them and they were not helpful.
NPR News: How An 'International Price Index' Might Help Reduce Drug Prices
Drugmakers hate the idea. But Nancy Pelosi and Donald Trump both say pegging the prices of U.S. medicine to what people elsewhere pay could save U.S. patients a bundle. Here's how an "IPI" might work.
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NPR News: Youth To Protest In Manhattan To Stop Climate Change
Thousands of students are expected to skip school Friday to march through Manhattan to demand global action to stop climate change. WNYC's Gwynne Hogan reports the protest has been long in the works.
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NPR News: North America Has Lost 3 Billion Birds, Scientists Say
Researchers estimate that the bird population has fallen by a quarter since 1970. More than 90% of the loss can be attributed to just a dozen bird families, including sparrows, blackbirds and finches.
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NPR News: The Perks And Perils Of Plant Parenthood
Millennials might be accused of killing a lot of industries. The plant business isn't one of them.
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Thứ Năm, 19 tháng 9, 2019
[discussion] what to say to get things covered?
Turmeric Health Benefits and Side Effects [Other]
NPR News: The Real Bachelor Party Hangover: A $12,460 ER Bill
The high ER charge for treating one Colorado groom's hangover the day before his wedding illustrates how emergency room bills have become major headaches for many Americans.
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[discussion] Dtc healthcare is bringing about pricing transparency and lowering costs
Big Pharma is making a huge presence in the lives of consumers once again. Many people see the pharmaceutical industry as obnoxious and money-hungry, especially when it comes to DTC or direct-to-consumer advertisement. You may have seen several TV, online and radio commercials, as well as advertisements in newspapers and magazines promoting companies that can deliver prescription drugs to consumers.
DTC advertising has been around for about ten years now, and people have had both positive and negative things to say about this form of marketing. Currently, New Zealand and the United States are legally able to provide DTC prescriptions to consumers. However, it's possible that Europe and Canada may soon offer this service to citizens as well if DTC continues to rise in popularity.
What is DTC advertising?
DTC advertising takes place when a promotion is viewed by someone who can't buy the advertised product on their own. In the US, most common form of direct-to-consumer advertising comes from pharmaceutical companies. The advertisements reveal the benefits of a drug, but also encourages the consumer to discuss the medication with their physician.
As with all types of marketing, DTC advertising advantages and drawbacks must be taken into consideration when you evaluate whether this form of marketing would be best for you. Here are some key points you'll want to consider.
The arguments that oppose DTC advertising are pretty familiar. DTC can increase the cost of prescriptions and has also contributed to the rise of hypochondriacs. Some also say that DTC provides a quick fix for many people who may need more extensive healthcare. When consumers know that they can simply order the prescriptions they need without having to visit the doctor, this gives Big Pharma another advantage and allows the industry to make money, even if the patient isn't accurately treated.
Of course, there are also several arguments in favor of DTC advertising. These benefits are not as common, but it's still important to consider the advantages. For instance, DTC advertising can make patients more aware of their options when it comes to treatment. These options can include new medications for a certain condition or disease. DTC advertisements can also help to decrease the stigma and raise awareness about certain disorders such as anxiety or depression and encourage patients to seek the medical attention they need. Overall, DTC healthcare can make it easier for patients to be motivated to take control of their health.
The research behind dtc healthcare
The pros and cons of DTC healthcare have been argued extensively over the years, and long-term studies have explored the effects of DTC advertising. Factors that have been included in the studies include the marketing budgets spent on DTC advertising, as well as the amount of prescriptions written and doctor surveys. The physicians were surveyed to the extent that DTC has affected doctor-patient relationships and the prescribing habits of physicians, as well as the distribution of cost when it comes to healthcare delivery. For instance, people who use DTC healthcare often have fewer hospital stays since they have easier access to their prescriptions.
Those who support DTC advertising also face criticism, since some people have pointed out that the FDA doesn't properly vet the ad. Recently, Pfizer made a decision to pull their ads for Lipitor that featured Dr. Rober Jarvik, and this "proved" to some critics that pharmaceutical companies sand the FDA should take more care when it comes to promoting DTC prescriptions. Due to pressure from Congress, the Lipitor ads featuring Dr. Jarvik were seen as misleading, since it is debatable whether he deserves sole credit for inventing the artificial heart. It is also important to note that Dr. Jarvik is not a cardiologist or a licensed physician.
It seems the ads for DTC healthcare are found everywhere, but the number and type of medications in advertisements is actually small. These advertisements also focus on new prescription drugs that are used to treat chronic diseases, as well as diseases that have symptoms patients an easily recognize, such as allergies, arthritis, depression or diabetes.
It's also important to note that DTC advertising only accounts for a small amount of the marketing budget for the prescription drugs that are promoted. According to the New England Journal of Medicine, spending for DTC advertising increased to 330% between the years of 1993 and 2005, but this only made up for 14% of all promotional expenditures in 2005. One of the biggest factors in marketing budgets is still marketing directly to physicians.
More things to consider when looking at dtc healthcare.
If you're still not sure if DTC healthcare is right for you, here are a few more things to consider. DTC provides customers with more education about the drugs they are currently taking or considering. When patients see their doctors, they usually don't know much about the drugs the physician will prescribe. If you see advertisements about new medications that are on the market, you can ask the doctor about alternative drugs that may be better suited for you.
If you're exposed to more DTC advertisements, you may be more encouraged to seek out treatment earlier. For most conditions, early diagnosis and treatment is essential; we've also seen that cancer is more effectively treated when it's treated early. DTC advertising can raise patient awareness and help you avoid severe symptoms associated with an illness.
You've likely noticed that DTC is also visually appealing. After all, most people would like to avoid going to the doctor as much as possible, and some people are even afraid of going to a physician. If patients are able to get their medications online, this can help them to get the treatment they need without having to go through the fearful experience of going to a doctor's office.
Keep in mind that DTC healthcare also means that a doctor will fulfill the prescription request. If you're interested in taking more control when it comes to your health, you can consult with an actual physician who will answer your questions about the prescription you've requested. While some people are concerned that DTC has caused people to suspect they have symptoms that aren't present, the doctor can explain this in a way that may put patients at ease and keep them from taking medications they don't need. Patients can also request additional information on the prescriptions and have pamphlets sent to their homes or PDF and other online documents emailed to them.
If you decide to go with DTC healthcare for some of most of your medical needs, it's important to be aware that the cost of your medications could increase. The advertising costs are built into the prices of the prescriptions. You should also do your own research when it comes to the side effects of your prescriptions, since these often aren't emphasized and it can be easy to overlook them when you're seeking treatment.
Ultimately, it's up to you to decide if DTC advertising is right for you, and the benefits depend on each individual patient. Your willingness to keep up with your treatment plan and learn all you can about your medications will play a huge role in whether this type of healthcare is best for you.
[Question - Other] How To Remove Dark Spots on Face Naturally
The choice for spotless pores and skin is quite not unusual amongst all. With the growing standards of splendor, the choice for a honest complexion is a slowly fading idea. Having a spotless and glamorous face is what’s greater desired amongst ladies. Women attempt numerous home remedies to remove dark spots on face naturally.
D panthenol vs panthenol
I bought d-panthenol on amazon. It is different than normal panthenol I used, somehow it is very oily. I wanted to use it for hair, but now I am not sure if it is the right one. What is the difference?