Hiring In-home services or repairs

Source: Centers for Disease Control

CDC offers the following tips for staying safe and slowing the spread of COVID-19 while scheduling services or repairs inside the home. This may include installation and repair of plumbing, electrical, heating, or air conditioning systems; painting; or cleaning services.

In general, the closer and longer you interact with others, the higher the risk of COVID-19 spread. Limiting close face-to-face contact and staying at least 6 feet away from other people is the best way to reduce the risk of COVID-19 infection, along with wearing masks and practicing everyday preventive actions. Before welcoming service providers into your home, consider these tips to help keep you, your family, and the service provider safe during in-home services or repairs:

Before the visit

  • Check with your local health department to see if there is a stay-at-home order in your state or local community that restricts non-essential activities or services. If a stay-at-home order is in effect in your community, consider if the service request is essential or if it can be delayed.
  • If you or someone in your home has COVID-19, has symptoms consistent with COVID-19, or has been in close contact with someone who has COVID-19, wait to schedule non-emergency services that require entry into your home until it is safe to be around others.
  • If you or someone in your home is at higher risk for severe illness from COVID-19, such as older adults or those with underlying medical conditions, consider not being inside the home during the service, or find someone else who can be in the home instead.
  • Do as much of the pre-service consultation as possible before the service provider arrives, to reduce the amount of time the service provider spends inside your home. For example, discuss the details of the service request on the phone or by email, and send pictures ahead of time.
  • Discuss any COVID-19 precautions the service provider is taking, including the use of masks for the duration of the service visit, any pre-screening procedures (such as temperature checks) and using the restroom during the service call.


During the visit

  • Do not allow service providers to enter your home if they seem sick or are showing symptoms of COVID-19.
  • Ask the service provider to wear a mask before entering your home and during the service visit. Also, you and other household members should wear a mask. Consider having clean, spare masks to offer to service providers if their cloth face covering becomes wet, contaminated or otherwise soiled during the service call.
  • Avoid physical greetings, for example, handshakes.
  • Minimize indoor conversations. All conversations with the service providers should take place outdoors, when possible, and physically distanced indoors, if necessary.
  • Maintain a distance of at least 6 feet from the service provider, and limit interactions between the service provider and other household members and pets.
  • During indoor services, take steps to maximize ventilation inside the home, such as turning on the air conditioner or opening windows in the area.


After the visit

  • If possible, use touchless payment options or pay over the phone to avoid touching money, a card, or a keypad. If you must handle money, a card, or use a keypad, wash your hands with soap and water for at least 20 seconds or use hand sanitizer with at least 60% alcohol after paying.
  • After the service is completed, clean and disinfect any surfaces in your home that may have been touched by the service provider.

If you have symptoms of COVID-19 and need to be tested, Save Your Spot at Fever and Upper Respiratory Illness Clinic at an IHA Urgent Care near you.

Practice Safe Sleep

Safe sleep guidelines for parents of infants.

Source: American Academy of Pediatrics (AAP)

According to the Centers for Disease Control, there has been a major reduction in the number of baby deaths during sleep since the recommendation to place babies on their back to sleep was introduced in the 1990s. Today, there are a number of additional safe sleep practices to keep sleeping babies safe and sound. Read on for the latest guidelines for infant safe sleep from the American Academy of Pediatrics.

SAFE SLEEP:

  • Put the baby to sleep in a safety-approved crib. Never place your baby to sleep on a couch, sofa, or armchair. This is an extremely dangerous place for your baby to sleep.
  • Have your baby share your room, not your bed. Place your baby’s crib, bassinet, portable crib, or play yard in your bedroom, close to your bed. The American Academy of Pediatrics recommends room sharing because it can decrease the risk of SIDS by as much as 50% and is much safer than bed sharing. In addition, room sharing will make it easier for you to feed, comfort, and watch your baby.
  • Put baby to sleep on their back. Some babies will roll onto their stomachs. You should always place your baby to sleep on the back, but if your baby is comfortable rolling both ways (back to tummy, tummy to back), then you do not have to return your baby to the back. However, be sure that there are no blankets, pillows, stuffed toys, or bumper pads around your baby, so that your baby does not roll into any of those items, which could cause blockage of air flow.
  • Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the baby’s sleep area. These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing. Do not overdress as the baby could overheat.
  • If your baby falls asleep in a car seat, stroller, swing, infant carrier, or sling, you should move him or her to a firm sleep surface on his or her back as soon as possible.

SAFE CRIB:

  • A firm, tight-fitting mattress
  • No loose, missing or broken hardware or slats
  • No more than 2 3/8” between slats (width of a soda can)
  • No corner posts over 1/16” high
  • No cutout designs in the headboard or foot board
  • If you are unsure of the safety of your crib, call the Consumer Product Safety Commission (CPSC) at 1.800.638.2772
  • For more information, visit the American Academy of Pediatrics at healthychildren.org and the Consumer Product Safety Commission at cpsc.gov

If you have questions or concerns about safe sleep practices for your baby, get in touch with your pediatric provider. Rest assured, they will help you and your baby get some much needed ZZZ’s, safely.

Active Kids!

Age-based physical activities for children

During these times we are all staying home more to keep our family safe, but remember….kids need physical activity to grow up strong and healthy! All children should be physically active every day, and kids over 6 years old should be moving enough get their heart rate up at least one hour a day. Read on for guidance from the American Academy of Pediatrics on how often your child should be active based on their age.

Infants:
Activity: Tummy time while awake.
Frequency: 30+ minutes throughout the day.

Toddlers:
Activity: Neighborhood walks or free play outside.
Frequency: 3+ hours throughout day.

Preschoolers:
Activity: Tumbling, throwing and catching.
Frequency: 3+ hours a day including 1 hour of moderate to vigorous activity.

Elementary Students:
Activity: Free play and organized sports focused on fun.
Frequency: 60+ minutes of activity most days. Muscle/bone strengthening activities 3 days a week.

Middle Schoolers:
Activity: Activities that encourage socialization. Avoid specializing in one sport.
Frequency: 60+ minutes of activity most days. Muscle/bone strengthening 3 days a week.

Teenagers:
Activity: Activities that encourage socialization and competition when appropriate.
Frequency: 60+ minutes of activity most days. Muscle/bone strengthening 3 days a week.


Don’t skip vaccines or checkups, or ignore concerns about your child’s health. IHA Pediatricians are offering options like telehealth and have implemented strict safety measures in practices. Call to schedule an appointment with your pediatric provider today!

IHA Lifestyle Medicine Fueling Friday

The IHA Lifestyle Medicine team is back Fueling Your Friday! Try this yummy Chickpea Avocado Dip this weekend – it’s like marrying hummus and guacamole.

Ingredients

• 2 small or 1 large ripe avocado
• 1 can garbanzo beans/chickpeas-drained and rinsed
• 1 lemon-squeezed
• Garlic powder to taste
• Pepper to taste

Preparation

• Add all ingredients to blender
• Keep in tupperware in refrigerator


What is Lifetstyle Medicine? Lifestyle Medicine is the use of evidence-based lifestyle therapeutic approaches, such as a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.

Your Baby’s Best Shot: FAQs About Vaccines

Parents today have no shortage of information and input on raising a child. It’s easy to get overwhelmed, especially for new parents. We want to ensure our children have all that they need to grow and develop normally, but sorting through the mountains of recommendations can be daunting, to say the least. For parents of newborns, a frequent topic of discussion during well visits centers around vaccines. Which vaccines does your child need and when should they receive them? Let’s breakdown the most frequently asked questions around vaccines for our littlest patients.

There are a lot of vaccines out there, does my child need all of them?
Just because a vaccine exists, doesn’t mean it is recommended for your child. Your doctor will discuss with you the routine vaccination schedule, which is based on current recommendations from the American Council on Immunization Practices. This schedule applies for all children living in the U.S. Additional recommended vaccines based on travel, disease outbreaks, or other unique circumstances, can be discussed with your doctor on an individualized basis.

Why does my baby get so many vaccines before they are two?
Vaccines are given based on a thoughtfully developed schedule to ensure children are protected when they are most vulnerable or likely to be exposed to an illness. Pertussis (whooping cough), for instance, can be life threating to an infant, so three doses of the vaccine are given in the first year of life. For illnesses that may not impact a child until adolescence, the vaccine is delivered at a later time.

Is it safe to give my baby several vaccines at one time?
Safety is of the utmost concern when giving a young child vaccines. That’s where the Centers for Disease Control’s Recommended Vaccine Schedule comes in. Extensive study and analysis have demonstrated conclusively that there is no risk or harm in giving multiple vaccines at once. Specifically, the Recommended Child and Adolescent Immunization Schedule in the U.S. has been carefully examined and has been proven to be safe and effective.

Does my child need vaccines?
Definitely. In addition to protecting our own children from serious, life-threatening illnesses, we all need to be mindful of the risks we pose to others to when we don’t vaccinate. We’re constantly interacting with others in public (for example at school, playgroups, parks) and there are many people that are not able to receive vaccines. These individuals include infants or those with compromised immune systems from chemotherapy or other conditions, are at mich greater risk of severe illness or death when exposed to some of these diseases. When you have your child vaccinated, you are helping to eliminate the risk of a harmful disease resurfacing. This not only protects your child, but also helps to protect others who are vulnerable to the spread of vaccine-preventable diseases.

How do I know which vaccines my child will receive for the first two years of their life and beyond?
Your baby’s provider can discuss the vaccine schedule which is right for your child. Talk with your pediatric provider about which vaccines your child needs, and when he or she should receive them.


Don’t skip vaccines or checkups, or ignore concerns about your child’s health. IHA Pediatricians are offering options like telehealth and have implemented strict safety measures in practices. Call to schedule an appointment with your pediatric provider today!

Originally posted June 2019

LIFE 101

Teaching your child to navigate basic life skills

Without a daily commute, extracurricular activities or playdates, you’re going to find yourself with a lot of extra time spent with your family. This presents a perfect opportunity to teach your kids some of the basic life lessons we squeeze in on the weekends and evenings. We’ve got some ideas to make learning these (and teaching) some basic life skills.

Ride a two-wheeler

Be sure your child’s helmet fits their head properly before the pedaling starts. Download this helpful step-by-step guide.

A long weekend is a perfect time to remove those training wheels. Be sure to protect your child from inevitable falls by having them wear jeans and knee and elbow pads. To make your job a little easier you may want to pick-up a grab bar to attach to the bike.

If you prefer to get started with a balance bike rather then jump right into a two-wheeler, give it a try on a grassy area with a slight incline. Learning to balance while rolling down a small hill will give your child a good start when they are ready to try riding a bike.

Tie Shoes

True, it’s much easier to continue to purchase slip-on or velcro shoes, but eventually your child will have a need to tie their shoes. That said, the things we do without really thinking about it can be the hardest to teach. Here are some tips and tricks to help teach the art of tying a shoe:

  • Choose soft, easy-to-hold laces. Many children do better with the wide, flat laces at first.
  • Use light-colored or better yet, two-tone laces for more contrast. Shoe tying will be easier for your child if they can easily see which is which.
  • Use a marker or pen to mark where your child should hold their laces.
  • Be prepared to teach more than one technique in case the first method you show your child doesn’t “stick.”
  • Watch a YouTube video with your child and learn a new knot together. Have your child “teach” you what they learned from the video.
  • There are many shoe tying books and toys available that may be helpful to your child as they learn to tie.

Learn the ABCs and Count

Download a version of the ABCs and a counting song and mix it in with your kid’s favorite playlist. Your child will learn to sing the ABC’s and count to 100 as quickly as they learned Baby Shark (doo doo doo doo doo doo).

Dressing and Undressing

Zippers can be a challenge for a 5-year-old suddenly on their own in Kindergarten (especially if they really have to go to the bathroom). Spend some time practicing zipping and unzipping pants and jackets.

Address an Envelope

Receiving mail during a quarantine is a major highlight of anyone’s day. So, why not brighten someone’s day and teach your children the art of addressing an envelope! You can purchase stamps online to avoid going to the post office in person.


Don’t put-off important checkups and vaccines!

Skipping vaccines and checkups can be dangerous. IHA Pediatricians’ offices are open, and safety measures are in place. Call to schedule your child’s next appointment!

Sun Safety: Protection is key for fun in the sun

Fifteen minutes. According to the Center for Disease Control, that’s all it takes for the sun’s ultraviolet (UV) rays to damage your skin. When you’re on having fun outside, 15 minutes goes by quickly. It feels great to soak up those rays, but they are harming your skin and are putting you at risk for long-term skin damage and worse, skin cancer. Before you head out into the sun for the day, take some time and precautions to keep yourself and your family safe all season long, and you’ll be golden for some fun in the sun!

USE SUNSCREEN
It’s one of the easiest ways to prevent skin cancer. Look for a sunscreen with broad spectrum protection against both UVA and UVB, an SPF of at least 30, and water resistant. When applying sunscreen, more is more. You want to be sure to get a thick layer of sunscreen on your skin in order for the SPF to do its job. For an average size person, remember the teaspoon rule, and adjust for all ages and body types: 1 teaspoon to the face/neck/scalp1 teaspoon for each arm1 teaspoon to the chest and abdomen, 1 teaspoon to the back, 2 teaspoons for each leg.

Sunblock lotions are the preferred choice, but if you are using a spray sunscreen, apply outside by holding the bottle close to the skin and spray on each area for approximately 6 seconds, or until the sunscreen is visible on the skin (typically, when it looks white). Then, rub it in. Don’t apply spray sunscreen directly to the face. Instead, spray generously into your hand and apply to your face as you would a lotion. Don’t forget to apply a lip balm with an SPF of 30, too!

Sunscreen will wear off throughout the day. Be sure to reapply every two hours and following exposure to water or sweat.

If you’re avoiding sunscreen because you don’t like how it feels on your skin or you had an allergic reaction, try another type or brand. There are a variety of choices by a variety of brands, so if you aren’t happy with one, try another until you find one that works with your skin. You may want to make an appointment with your primary care provider or dermatologist to discuss your individual needs. After all, the best sunscreen is the one you will wear!

AVOID EXPOSURE BETWEEN 10 AM AND 4 PM
Have you heard of the shadow rule? If your shadow is shorten than you are in real life, the sun’s rays are strong. During this time, you should avoid exposure or follow precautions to protect yourself and your family. For our region in the Midwest, the sun is most intense from 10:00 a.m. to 4:00 p.m., so you’ll want to be the most vigilante in protecting your skin during this time.

USE SUNGLASSES
Your eyes will absorb those harmful rays much like your skin does. Look for sunglasses that block and absorb UVA and UVB light. The lenses should fit close to the skin and be large enough to cover your eyes and the surrounding areas. The bigger the better! Polarized lenses will help eliminate glare, which is great for driving or days in the water or snow.

DRINK MORE WATER
When you’re sweating, you are losing water. Drink plenty of water throughout the day, especially in hot weather to keep dehydration at bay. Don’t wait until you feel thirsty. Also, look for signs of heat exhaustion such as; feeling overheated, tired or weak. Nausea, headaches and dizziness are also indications that it’s time to get out of the sun, cool down and drink some water. Heat stroke is a more serious condition. If you or someone in your family stops sweating, has red and/or hot skin, a high temperature, confusion or is suddenly uncoordinated, seek medical attention right away.

GO LONG!: WEAR PROTECTIVE CLOTHING
Long-sleeved shirts and long pants provide an extra layer of protection while spending time out in the sun. Look for clothing made with tightly woven fabrics. Those linen pants aren’t going to protect you from the sun, so be sure to wear sunscreen underneath. When playing the water, look for bathing suits that feature a sun shirt, especially for little ones.

HATS OFF ON!: WEAR A BROAD RIMMED HAT
Wearing a hat with a full brim is a great way to protect the scalp, ears, face and neck from exposure to the sun’s UV rays. Tightly woven fabric is the key to a good hat, straw hats are cute, but don’t provide the protection you need. When purchasing sun hats for the family, be sure to pick the correct sizes for each person. Kids will pull off a hat that slips down over their eyes.Seek the shade & avoid direct sunlight

Trees or shelters block the sun’s UV rays and provide ultimate protection. Seek out these spaces when spending time outdoors to help protect yourself and your family from painful sunburns and help reduce the risk of skin cancer. When you can’t find shade, make it! Invest in a beach umbrella or tent to shield your family from the sunlight.

BE CAUTIOUS OF REFLECTIONS
Your exposure to the sun’s rays increases when the sun shines onto and reflects off of bright surfaces, like water, sand or house paint, for example. When spending time near a reflective surface, ensure everyone is sporting sunglasses and sunscreen or protective clothing are being used consistently.

TANNING
Don’t. Tan skin is damaged skin and the impact can last or even shorten a lifetime. Tanning should not be part of a beauty regiment at any point in a person’s life.

PROTECTION 365 DAYS
Skin cancer prevention is not seasonal. Sure, we wear less clothing and spend more time outside in the sun’s rays during the summer months, but protection from those rays is just as important during the winter months. UV rays reflect off snow just as they do off of sand, water and concrete. Apply sunscreen to the face and any other exposed skin, wear sunglasses and lip balm every day. When it comes to sun safety, there’s a lot of information to soak in. Download this handy checklist and keep it in your beach bag to help ensure you and your family are covered for summer skin protection.

Sun Safety Checklist

For questions concerning dangers to your skin from the sun, consult with your dermatologist.


Did you kow you can schedule video appointments with your providers?

Originally published July 2019

An open letter to the communities we serve.

Who could have imagined the struggles that all of us would encounter from this unprecedented global pandemic? Not only has it brought our state and country great economic stress, but it also has changed how healthcare services will be delivered forevermore.

Early in the crisis, IHA’s healthcare providers and staff took multiple steps to help our community respond to the pandemic. Within a matter of days, our medical group opened drive-thru testing sites, implemented a free on-line COVID screening tool, and designated locations where patients with fevers and upper respiratory symptoms could be treated. Additionally, we rolled-out video appointments for all our patients and began piloting home care visits for our most vulnerable patients.

These are complicated times with rapidly changing standards, which is why IHA has been providing regular updates to our staff and providers, as well as our patients. In a matter of weeks, IHA has addressed the most significant and complex changes to face healthcare in our lifetime, but we are not done. We are moving toward what many are calling the “new normal.”

Staying safe in the “new normal”.
Video appointments continue to be our primary method used to treat patients. Since launching this service just a few weeks ago, we have
completed nearly 25,000 video appointments. The decline in new COVID cases is enabling IHA to reconnect in-person with patients whose
appointments, surgeries or outpatient procedures were cancelled. Over the next two weeks, our physicians and practitioners will slowly increase the number of in-person appointments they offer and surgeries they perform. As we reopen more offces, we want to assure you that we are committed to being both responsive and responsible, navigating these unusual times with everyone’s safety in mind.

Numerous safeguards and quality measures are in place across IHA to care for COVID and Non-COVID patients. These include our use of telehealth visits which are actively being embraced by our patients and our providers alike.

IHA is following CDC guidelines and has put additional cleaning and screening processes in place to keep anyone entering an IHA building
safe. These processes include requiring all staff and patients to wear masks and having their temperature checked before entering a practice. Along with maintaining appropriate social distancing, items such as hand sanitizer and tissues will be prominent in every location.

Saving lives, improving quality of life.

Our difficult journey is not over, but we must look to the future. Children need to maintain their immunization schedules, older adults or those with complex medical issues need their health and medications regularly monitored, and further delaying surgeries or exploratory procedures may cause serious harm or lead to other health problems. The steps we are following to reopen are being implemented with extreme care and will be constantly evaluated. As a member of Saint Joseph Mercy Health System, we are working together on safety and security protocols. We have developed COVID-Free Zones, areas where we provide care only for people not known to have COVID-19 or COVID symptoms. We wish to assure the community that our healthcare delivery system is working closer than ever to keep your health and wellness at the center of everything.

Over the past two months, no one industry has learned more than healthcare about the need to change and adapt quickly in order to
care for those we serve. Our lives have drastically changed but fulfilling IHA’s mission of healing will remain with us forever. Please know that we stand ready to care for you. IHA’s motto “our family caring for yours” has never meant more to us than it does today.

We encourage you to call your provider’s office or visit ihacares.com today to learn about the many ways we can connect and safely provide the care that you need. IHA is here for you.

Mark LePage, MD | IHA CEO

Cindy Elliott, RN | IHA President & COO

Coping with Stress

Helpful reminders for when you feel stressed

Source: Centers for Disease Control and Prevention (CDC)

Even the most laid back, easy-going people feel stressed sometimes. And considering our current situation, a pandemic and all, stress pretty much goes with the territory. Luckily, the CDC has some important reminders to help manage stress and support yourself.

Take breaks from watching, reading or listening to the news.

The news is everywhere, it’s so hard to escape. If your stress levels are up, then an escape may be just what you need.  Hearing about the pandemic repeatedly can be upsetting.

Take care of your body.

When you feel like stress is taking over, take deep breaths, stretch or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and avoid alcohol and drugs.

Make time to unwind.

Make a list of the things you enjoy most. What can you do right now? What can you plan to do in the future, to help give you something to look forward to? If you’re a person that creates a daily schedule, include some time to do what makes you happy. You may also try setting an alarm or reminder on your digital calendar to stop and take a few minutes for yourself.

Connect with Others.

Consider who you trust in your life. Who do you think would best understand your current concerns? Seek out people in your life that can help you navigate stressful feelings and lighten your load. With social distancing rules currently in place, you may need to be creative in how you connect with others, phone and video calls work great!

Know when it’s time to seek medical care.

If your stress is keeping you from your daily activities or social interactions, reach out to your healthcare provider. They will be able to help you find a solution and get you feeling like yourself again!

Boost Your Immune System

Lifestyle Medicine tips for a stronger immune system

Source: American College of Lifestyle Medicine

In the last few weeks, the immune system has been brought into the spotlight. When functioning properly, the immune system identifies a variety of threats, including viruses, bacteria and parasites, and distinguishes them from the body’s own healthy tissue, according to Merck Manuals. A healthy immune system could be the difference between getting sick and staying healthy. Read on for tips on strengthening your immune system focusing on Lifestyle Medicine. Increasing your body’s immune response is not a guarantee against infection, but it’s a good start.

Mind Your Stress

Pause. Take a few seconds to consider your breathing, listen to a favorite song, or watch a funny video. The stress hormone, cortisol, suppresses immune response. Being mindful, even in small doses, reduces stress and as a result, cortisol production.

No Smoking

Avoid smoking, vaping, or inhaling any substance, which can be toxic to the lungs.

Healthy Eating

What you eat makes all the difference! For strong immunity, consume a wide array of fiber-filled, nutrient-dense, and antioxidant-rich whole plant foods at every meal. Choose a rainbow of fruits and vegetables, eat your beans, consume whole grains, and use a variety of herbs and spices to enhance flavors. Stay hydrated with water!

Purchasing fruit and veggies is as easy as 1, 2, 3!

  1. Commit to the piece of produce you choose. Try not to manipulate
    the produce items by touching them and placing them back.
  2. Wash your hands with clean water and soap for a minimum of 20
    seconds after returning from the grocery store. Hand sanitizer for 60
    seconds can also be used.
  3. Produce items should always be washed thoroughly with cold water prior consumption.

Quality Sleep

Aim to sleep for 7 to 9 hours. Develop a routine: Set an alarm for when to go to sleep and when to wake up. Make sure your room is cool, dark, quiet, and comfortable. Avoid screens at least 90 minutes before bedtime. Practice a “wind down” ritual, like listening to soft music, writing in a journal, or reading a book.

Activity

Regular, moderate physical activity is vital to keeping the immune system strong! While Physical Activity Guidelines recommend at least 30 minutes, 5 days a week, as little as 20 minutes can suppress inflammation and support immunity.

Connectivity

Physical distancing is essential when contagious disease risks are high, but not at the expense of being isolated or lonely. Connect with friends and family via FaceTime, Zoom sessions, texting, and phone calls. Positive emotions, which are shown to improve immunity, arise from even brief, virtual social connections.

What is Lifetstyle Medicine? Lifestyle Medicine is the use of evidence-based lifestyle therapeutic approaches, such as a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.

Learn more about Lifestyle Medicine at IHA.