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Posted by: | Posted on: January 30, 2024

Here’s Why You Should Avoid Acetaminophen Use During Pregnancy


Reproduced from original article:
https://articles.mercola.com/sites/articles/archive/2024/01/29/avoid-acetaminophen-use-during-pregnancy.aspx
The original Mercola article may not remain on the original site, but I will endeavor to keep it on this site as long as I deem it to be appropriate.

Analysis by Dr. Joseph Mercola January 29, 20214

avoid acetaminophen use during pregnancy

STORY AT-A-GLANCE

  • Although most consumers believe that over-the-counter medications are safe and effective, recent data offers more evidence that acetaminophen during pregnancy increases your child’s risk of attention deficit hyperactivity disorder (ADHD)
  • Using acetaminophen during pregnancy can also increase your child’s risk of autism spectrum disorder (ASD). Acetaminophen is found in over 600 medications that are commonly consumed, making it easy to cross the line between a safe dose and a harmful one
  • Data show that children who are exposed to acetaminophen after birth to reduce fever and discomfort after vaccination may also have an increased risk of autistic disorder
  • I believe it’s important to stay away from as many potential toxins as possible to protect the health of your child. Besides steering clear of alcohol, street drugs and unnecessary prescription drugs, consider avoiding plastic children’s toys, using glass for food and beverage storage, installing a whole-house water filter, using only natural cleaning products and toiletries, and avoiding any products with “fragrance”

In general, most consumers believe that over-the-counter medications are both helpful and safe. The results of one survey1 showed that as familiarity with the product grew, so did the consumers’ impression of the safety and efficacy of the product. The American College of Obstetricians and Gynecologists (ACOG) warns pregnant women to avoid substances that are not required for medical reasons to support a healthy pregnancy.2

Despite mounting evidence to the contrary, ACOG, obstetricians and gynecologists from across the U.S. have typically identified acetaminophen (Tylenol) as a safe pain reliever for pregnant women.3 Yet, another study4 published in January 2024 found an increased risk of attention deficit hyperactivity disorder (ADHD) in children when mothers used acetaminophen, particularly during the second trimester.5

According to the Centers for Disease Control and Prevention,6 roughly 6 million children aged 3 to 17 years were ever diagnosed with ADHD. This is 9.8% of the population using data extracted from 2016 to 2019. Additionally, that number rose dramatically between 2003 and 2011, from 4.4% to 6.4% of the general population.

ADHD is a neurodevelopmental disorder that affects an individual’s ability to manage their attention, stay organized, and control their behavior. Data also show that 64% of those with ADHD also have at least one other mental, emotional, or behavioral disorder.7 While the featured study focused on the neurological implications in children, other data show how acetaminophen affects behavior in adults.

Acetaminophen is found in over 600 medications and is one of the most consumed drugs in the U.S. Researchers tested the hypothesis that 1,000 mg could influence judgment and decisions. In three double-blind, placebo-controlled studies in healthy adults, they found acetaminophen increased risk-taking behavior.8 The most recent data demonstrate that exposure during pregnancy may increase a child’s risk of symptoms of ADHD.

Acetaminophen During Pregnancy Linked to ADHD in Children

In a 2021 consensus paper9 researchers called for precautionary action in the use of acetaminophen (paracetamol) in light of increasing research data that suggests it may alter fetal development. The review triggered a response from ACOG in which they wrote that there is “no clear evidence that proves a direct relationship between the prudent use of acetaminophen during any trimester and fetal developmental issues.”10

The most recent paper to support data that acetaminophen during pregnancy could affect neurological development in children was part of the Illinois Kids Development Study that involved tracking prenatal chemical exposure. The data showed that in women who had higher acetaminophen usage during the second trimester, there was an increase in attention-related problems and ADHD-type behavior.11

The researchers used the Child Behavior Checklist (CBCL) to identify behaviors associated with attention deficit and found increased scores at ages 2, 3 and 4 years.12 The association appeared to be dose-related, as women with higher exposure during the second trimester had children with higher CBCL scores for attention problems, ADHD and externalizing behavior.

Children whose mothers had a higher cumulative exposure across the entire pregnancy had increased scores for attention problems and ADHD at ages 2 and 3. Megan Woodbury led the research as a graduate student alongside comparative biosciences Professor Emerita Susan Schantz. A recent study by these scientists also found that exposure to acetaminophen during pregnancy led to language delays in children.13

One difference between this study about exposure to acetaminophen during pregnancy and past studies was that researchers in the current study asked pregnant women about acetaminophen use six times during the course of their pregnancy while in other studies they were asked at most once per trimester. Caregivers were also asked dozens of standardized questions about their children’s behavior.

“The kinds of behaviors the caregivers reported included things like the child talking out of turn, not paying attention, not being quiet when they were supposed to be quiet, not sitting down when they were supposed to be sitting down, and being a little aggressive with other children,” Schantz said.14

Acetaminophen During Pregnancy Also Raises Risk of Autism

A study15 published in 2020 in JAMA Psychiatry strengthened the link between acetaminophen use during pregnancy and ADHD and the risk of autism spectrum disorder (ASD). According to the authors:

“Prior studies have raised concern about maternal acetaminophen use during pregnancy and increased risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in their children; however, most studies have relied on maternal self-report …

In this cohort study of 996 mother-infant dyads from the Boston Birth Cohort, cord plasma biomarkers of fetal exposure to acetaminophen were associated with significantly increased risk of childhood attention-deficit/hyperactivity disorder and autism spectrum disorder.”

Of the 996 participants, only 32.8% were neurotypical, 25.8% had only ADHD, 6.6% had only autism, 4.2% had both ADHD and autism and 30.5% had other types of developmental delays. The association also appeared to be dose dependent. The researchers measured cord plasma biomarkers for acetaminophen and found those in the first tertile had a far lower risk of diagnosis of ADHD and ASD than those in the second and third tertiles.

The researchers concluded that the biomarkers in cord blood of fetal exposure to acetaminophen were significantly associated with an increased risk of diagnosis of childhood ADHD and autism in a dose-response fashion, writing that their findings “support previous studies regarding the association between prenatal and perinatal acetaminophen exposure and childhood neurodevelopmental risk.”16

As I reported in 2021, more data document disturbing links between acetaminophen use during pregnancy and neurological problems in children, including poor gross motor development, communication issues, increased risk of preeclampsia, and a moderately increased risk of undescended testicles and boys.

Data also shows that acetaminophen used after birth may also be linked to an increased risk of autism. In a small study published in 2008, the researchers concluded that using acetaminophen after vaccination may increase the risk of autism, writing “acetaminophen use after measles-mumps-rubella vaccination was associated with autistic disorder.”17

While parents give babies and infants Tylenol for numerous reasons, one instance in which Tylenol is routinely used is after childhood vaccinations. According to 2009 research18 published in the journal Lancet, acetaminophen might render vaccinations less effective when administered together.

Infants who received acetaminophen right after getting a vaccination experienced lowered immune response and developed significantly fewer antibodies against the disease they were vaccinated against.

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Acetaminophen During Pregnancy Associated With More Risks

In addition to the risks to babies during pregnancy, acetaminophen use can also increase risks to the mother and other adults. Overdose is responsible for nearly half of all acute liver failure cases in the U.S.19 While it is considered safe when taken as recommended, the margin between a safe dose and a lethal one is small.

Additionally, you may not always recognize that the over-the-counter drugs you are taking contain acetaminophen. Harvard Health20 recommends caution when dishing out acetaminophen as it is often contained in many other over-the-counter medications.

Acetaminophen pills are available in 325 mg, 500 mg or 650 mg. If you take two 500 mg pills three times a day, you have quickly reached the low end of the recommended dose range. Acetaminophen is metabolized in the liver, so drinking alcohol can cause the liver to convert acetaminophen into a toxic by-product. It is important to recognize that acetaminophen sickens tens of thousands of people every year, and kills several hundred more.

Tips for a More Toxin-Free Pregnancy

I believe it is essential to abstain from as many potential toxins as possible to protect the health of your child. Our environment is saturated with a wide variety of toxic substances, so you may not be able to defend against each one. However, you have a great deal of control over the medications you take and within your immediate household.

For example, it’s important to understand the chemicals you ingest in your food and drink and what’s absorbed through your skin from the household and personal care products you use. Each of these can have an impact on your child’s development and long-term health. In the past few decades, the prevalence of ADHD and autism have both skyrocketed, which indicates that something is going terribly wrong in the environment.

Unfortunately, our children are paying the price for a chemical-laden lifestyle, including the overuse of over-the-counter drugs like acetaminophen. Consider avoiding any unnecessary drugs or medications, including the COVID jab, which the CDC has officially recommended for pregnant women. This can have long-lasting ramifications for your child and your future reproductive health.

As much as you’re able, buy and eat organic produce and grass fed, pastured animal foods to reduce your exposure to agricultural chemicals like glyphosate and others. Don’t eat processed, prepackaged foods of any kind, which helps you automatically avoid pesticides, artificial food additives, dangerous artificial sweeteners, food coloring, MSG and unlabeled genetically engineered ingredients.
Avoid conventional or farm-raised fish, which are often heavily contaminated with PCBs and mercury. Wild-caught Alaskan salmon is one of the very few fish I still recommend eating, as well as small fatty fish like anchovies, sardines, mackerel and herring. If you don’t eat these on a regular basis, consider taking a krill oil supplement to optimize your omega-3 level.
Store your food and beverages in glass rather than plastic, to avoid exposure to plastic chemicals known to disrupt endocrine function, and avoid using plastic wrap and canned foods.
Install an appropriate whole-house water filter on all your faucets (even those in your shower or bath).
Only use natural cleaning products in your home.
Switch over to natural brands of toiletries such as shampoo, toothpaste, antiperspirants and cosmetics. The Environmental Working Group has a great database21 to help you find safer personal care products.
Avoid artificial air fresheners, dryer sheets, fabric softeners or other synthetic fragrances. Relinquish the idea that fragrance equals “clean.” It doesn’t. Clean laundry does not smell like anything at all.
Replace your nonstick pots and pans with ceramic or glass cookware to avoid toxic PFOA chemicals.
When shopping for baby items, look for “green” toxin-free alternatives. Avoid plastic toys, especially teething toys, and make sure items like mattresses, car seats and nursing pillows do not contain toxic flame-retardant chemicals.
Replace your vinyl shower curtain with one made of fabric or install a glass shower door. Most flexible plastics, like shower curtains, contain dangerous plasticizers like phthalates.

Posted in Acetaminophen, ADHD, Autism, Children, Pregnancy, Toxins | One Comment »

Posted by: | Posted on: December 23, 2021

US Autism Rate Is Now 1 in 44


Reproduced from original article:
https://articles.mercola.com/sites/articles/archive/2021/12/23/autism-rate-1-in-44.aspx
The original Mercola article may not remain on the original site, but I will endeavor to keep it on this site as long as I deem it to be appropriate, and will not be bullied into removing it.

Analysis by Dr. Joseph Mercola     Fact Checked     December 23, 2021

autism rate 1 in 44

STORY AT-A-GLANCE

  • In the mid-1960s, the autism rate was 1 in 10,000. By 2012, it had shot up to 1 in 88. In 2016, it was 1 in 68, and now it’s 1 in 44 8-year-olds
  • Rates vary widely from state to state. In California, where incidence is the highest, 1 in 26 8-year-olds has a diagnosis of autism. Missouri, which has the lowest incidence, has a rate of 1 in 60
  • Improved diagnosis alone cannot explain this trend. Genetics play only a minor role, and even then, primarily only when combined with toxic exposures
  • Glyphosate appears to be a leading contributor to autism
  • Other contributing factors include maternal antibodies associated with autoimmune diseases, maternal immune system overactivation and mitochondrial dysfunction (typically involving electron transport chain overactivity). Mitochondrial abnormalities are suspected of being involved in as many as 80% of cases

In the mid-1960s, the autism rate was 1 in 10,000.1 By 2012, it had risen to 1 in 88,2 then 1 in 68 as of 2016,3 and now, we’re looking at an autism rate of 1 in 44 8-year-olds, although rates vary widely from state to state.4

In California, where incidence is the highest, 1 in 26 8-year-olds has a diagnosis of autism. Missouri, which has the lowest incidence, has a rate of 1 in 60. According to the U.S. Centers for Disease Control and Prevention, the dramatic uptick is in part due to improved and more comprehensive identification and diagnosis.

However, improved diagnosis alone cannot explain this trend. One in 44 children were not autistic in the 1980s, with or without diagnosis. No, something is going on. One or more environmental factors are clearly having a devastating impact on our children.

Mitochondrial Dysfunction in Autism

According to an October 2020 scientific review5 in the journal Seminars in Pediatric Neurology, “Several lines of evidence implicate mitochondria in the pathophysiology of autism spectrum disorder (ASD).” For years, autism was believed to be due to genetics, but empirical studies have proven genetic predispositions play a very small role.

The authors point to “novel abnormalities” in mitochondrial function that have been found in autistic children, and the fact that treatments targeting mitochondrial dysfunction, such as L-carnitine supplementation and a ketogenic diet, have been fruitful.

In 2007, approximately 4% of autistic children could be diagnosed with a definite mitochondrial disease. More recent investigations looking at mitochondrial biomarkers and electron transport chain activity suggest mitochondrial abnormalities may be involved in as many as 80% of cases. Biomarkers of mitochondrial dysfunction include elevated levels of:

Lactate Pyruvate
Alanine Creatine kinase
Ubiquinone Acyl-carnitines
Carnitine (low levels being an indication of dysfunction)

As noted by the authors, this is “remarkably interesting” because mitochondria are “very vulnerable to environmental factors.” In other words, something in our environment is triggering mitochondrial dysfunction in an ever-growing percentage of children. The question is what?

Children whose autism is rooted in mitochondrial dysfunction will typically have a key set of symptoms that include:

  • Fatigability
  • Gastrointestinal disorders
  • Seizures and/or epilepsy
  • Motor delay and/or ataxia and/or muscle weakness
  • Unusual neurodevelopmental regression, including multiple regressions or regression later than commonly associated with ASD

Mitochondrial Overactivity

While classic mitochondrial disease is defined, at least in part, by severe deficits in electron transport chain activity, in children with ASD, mitochondrial dysfunction tends to involve overactivity. According to the authors:6

“… we have shown that about one-third of LCLs [lymphoblastoid cell lines] derived from children with ASD repeatedly show elevated respiratoryiou rates, approximately 200% of controls, for respiratory parameters associated with adenosine triphosphate production.

We have also demonstrated the consequences of elevated respiratory rates; specifically, this subset of ASD LCLs are more sensitive to acute exposure to reactive oxygen species (ROS) such that respiratory rates drop precipitously with acute increases in ROS.

We hypothesized these changes represent an adaptive response to previous environmental exposures, a phenomenon known as mitoplasticity.

To support this hypothesis, we demonstrated that elevated respiratory rates can be induced in LCLs with prolonged exposure (96 hours) to mild ROS, a microenvironment that simulates the effect of environmental toxicants on mitochondria.

Additionally, we have demonstrated that this subset of LCLs respond differently to environmental agents associated with ASD, including trichloroacetaldehyde hydrate and ethylmercury, and enteric short chain fatty acids propionate and butyrate, as compared to ASD LCLs which do not demonstrate these high respiratory rates at baseline.”

Important Nutritional Supplements

Two helpful treatments have already been mentioned: L-carnitine supplementation and ketogenic diets. Studies evaluating ketogenic diets and ASD have found them to be well-tolerated by a majority of children.

A review of four studies found 18% of children saw significant improvement on a ketogenic diet, 40% reported moderate improvement and 32% had mild improvement. Only 8% experienced a worsening of their symptoms.7

In cases where the ASD is caused by mitochondrial dysfunction, however, supplementing specific cofactors become important. The good news is this kind of supplementation is very safe and well tolerated. There’s virtually no risk involved, in terms of adverse side effects. Among the most important nutritional cofactors are:8

B vitamins, including niacin (B3), riboflavin (B2), biotin (B7), thiamine (B1), pyridoxine (B6), pantothenic acid (B5), methylcobalamin (B12), reduced folate (B9) Coenzyme Q10 or the reduced form, ubiquinol
L-carnitine or acetyl-L-carnitine Creatine monohydrate
Alpha-lipoic acid Vitamin E
Vitamin C N-acetyl-L-cysteine (NAC)
Zinc

Benefits of L-Carnitine and CoQ10

Of these, L-carnitine has been most widely studied. As explained in this paper:9

“Two medium sized (n = 30, 30) double-blind placebo-controlled studies using L-carnitine treatment (50 mg/kg/d for 3 months and 100 mg/kg/d for 6 months) found that scores on the Childhood Autism Rating Scale (CARS) improved with L-carnitine as compared to placebo with one study finding that greater symptomatic improvement was correlated with a greater increase in blood carnitine levels.

A small (n = 10) 8-week open-label trial of L-carnitine used particularly high doses (up to 400 mg/kg/d in 3 divided doses, maximum of 6000 mg/d) …

Several parental rated measures showed improvements in behavior and hyperactivity before correction for multiple comparisons and improvements in language correlated with post-treatment blood carnitine levels. Children with ASD and genetic mutations in the carnitine pathway also appear to response to L-carnitine.”

CoQ10 has also been evaluated in clinical trials. In one, 50 mg of ubiquinol was given twice a day for three months. Children who attained a CoQ10 blood level above 2.5 umol/L saw improvements in communication, interactions, sleep and food rejection.10

A three-month-long regimen of L-carnitine, CoQ10 and alpha-lipoic acid also produced encouraging results, improving mitochondrial function and ASD-related behavior. When the children discontinued the cocktail, their behavior worsened again.

Autism and Autoimmunity

Previous research also suggests ASD may have an autoimmunity component. As explained in a 2009 paper titled “Autoimmunity in Autism”:11

“Increasing evidence of autoimmune phenomena in individuals with autism could represent the presence of altered or inappropriate immune responses in this disorder, and this immune system dysfunction may represent novel targets for treatment.

Furthermore, in recent studies, antibodies directed against the fetal brain have been detected in some mothers of children with autism; these antibodies have the ability to alter behavioral outcomes in the offspring of animal models.”

Research12,13 published in 2013 found that more than 1 in 10 mothers of autistic children had antibodies associated with autoimmunity that adversely reacted with proteins in the brain of the baby, resulting in ASD. The authors point out that any activation of the mother’s immune system “might lead to an increased risk of a child with ASD.”

In light of the COVID injection campaign, the possibility of autoantibodies playing a role in ASD is extremely troublesome, as autoimmune diseases are a potential side effect. We don’t yet really know the extent of which the SARS-CoV-2 spike protein interacts with the human brain, but it’s clearly not beneficial.

Women, in particular, are suffering neurological dysfunction as a result of the COVID shot. How might the spike protein affect offspring? That’s still too early to say, but I suspect we’ll come to find that the effect can be devastating.

Toxic Chemicals Implicated in Autism

Not surprisingly, exposure to toxic chemicals in utero has also been identified as a potentially causative factor. According to the National Academy of Sciences, an estimated 3% of all neurobehavioral disorders in children are caused by toxic exposures.

Another 25%, the interaction of toxic exposures and genetic factors is thought to be causative.14,15 In 2012, scientists identified 10 chemicals suspected of causing learning disabilities and ASD:16

Lead Methylmercury
Polychlorinated biphenyls (PCBs) Organophosphate pesticides, including glyphosate
Organochlorine pesticides Endocrine-disrupting chemicals
Automotive exhaust Polycyclic aromatic hydrocarbons (PAHs)
Brominated flame retardants Perfluorinated compounds

Of these, glyphosate is a top suspect17,18 for the simple reason that exposure to it is so widespread. Research19 published in 2019 found women exposed to 11 commonly used pesticides — including glyphosate — during pregnancy have a higher risk of having a child diagnosed with autism.

Pregnant women who lived within a 2,000-meter (1.24 miles) radius of a highly-sprayed area were 10% to 16% more likely to have children diagnosed with autism than those who lived farther away. As reported by Time:20

“When they looked at diagnoses of autism spectrum disorder that also came with intellectual disabilities, they found on average 30% higher rates among children who were exposed to the pesticides while in utero. Exposure in the first year of life increased the risk of autism by up to 50% compared to those not exposed to certain pesticides.”

Glyphosate Is Likely a Key Culprit

Stephanie Seneff, Ph.D., who has spent a large portion of her career studying glyphosate, believes it is a significant cause or contributor to autism. She’s shown glyphosate:

  • Disrupts your gut microbiome
  • Impairs peristalsis — a feature that is exceedingly common in children with autism21
  • Inhibits bile acid release by impairing gallbladder contraction — Many autistic children have very pale stool, suggestive of low bile acid levels
  • Impairs digestive enzymes — Many autistic children also have undigested particles in their stool, which suggests a lack of digestive enzymes. And, indeed, glyphosate affects your digestive enzymes, particularly trypsin, pepsin and lipase

The Roles of GI Inflammation and Maternal Gut Bacteria

Another potential trigger is maternal gut inflammation. Research22 published in early December 2021 found that when pregnant mice were challenged with immune activation, it changed their gut microbiota. This altered microbiota in turn primed the offspring for intestinal inflammation that resulted in neurodevelopmental disorders. MIT News reported the findings, noting:23

“Infection during pregnancy with elevated levels of the cytokine IL-17a may yield microbiome alterations that prime offspring for aberrant immune responses …

When a mother experiences an infection during pregnancy and her immune system produces elevated levels of the molecule Interleukin-17a (IL-17a), this can not only alter brain development in her fetus, but also alter her microbiome such that after birth the newborn’s immune system can become primed for future inflammatory attacks.

In four studies beginning in 2016,24 study co-senior authors Gloria Choi of MIT and Jun Huhof Harvard University traced how elevated IL-17a during pregnancy acts on neural receptors in a specific region of the fetal brain to alter circuit development, leading to autism-like behavioral symptoms in mouse models.

Their new research … shows how IL-17a can act to also alter the trajectory of immune system development. ‘We’ve shown that IL-17a acting on the fetal brain can induce autism-like behavioral phenotypes such as social deficits,’ says Choi …

‘Now we are showing that the same IL-17a in mothers, through changes in the microbiome community, produces co-morbid symptoms such as a primed immune system.’

The researchers caution that the study findings are yet to be confirmed in humans, but that they do offer a hint that central nervous and immune system problems in individuals with autism-spectrum disorders share an environmental driver: maternal infection during pregnancy.”

Here, the COVID-19 pandemic may end up worsening an already terrible trend, as the infection is associated with elevated IL-17a. IL-17a is a key molecule in both the innate and adaptive immunity that helps mobilize your immune system response during early infection. It’s been singled out as being involved in the thrombotic and vascular mechanisms of COVID-19 specifically.25

One October 2021 study26 suggested IL-17a acts as a silent amplifier of the COVID-19 immune response, resulting in some of the worst side effects associated with the infection. While pregnant women are universally instructed to get the COVID shot to protect themselves from the infection, there’s every reason to suspect the injection may cause far more harm than the infection itself.

If you get COVID while pregnant, you may or may not have a serious case of it, but if you take the shot, you have a 100% chance of suffering the effects of it, which for many include dramatically elevated levels of inflammation.

From my perspective, getting the COVID jab because you fear what COVID-19 might do to you and/or your baby is actually irrational, as your risk of adverse effects from the shot is exponentially higher than your risk of severe COVID-19 infection.

Autism Is a Multifactorial Condition

A number of other culprits could also be named, such as retroviruses (which the COVID shots can reactivate) and electromagnetic field (EMF) exposure. According to Judy Mikovits, Ph.D., a retrovirus family known as xenotropic murine leukemia virus-related viruses (XMRV) may play a causal role in autism.27

Disturbingly, one source for XMRVs is contaminated childhood vaccines. Mikovits details the history of this in her book, “Plague: One Scientist’s Intrepid Search for the Truth About Human Retroviruses and Chronic Fatigue Syndrome (ME/CFS), Autism and Other Disease.”

In previous interviews with me, Mikovits has also expressed concern that the COVID shots may activate latent XMRV infection. If it does, we could expect the autism rate to explode at an even more exponential rate than we’re seeing already.

I predict the COVID shots will be found to contribute to autism in a number of different ways. But even in the absence of these injections, it’s clear that environmental toxicities are wreaking havoc with our children’s health.

There’s no single answer to this problem. Since many different toxins can contribute, preventing autism must include the elimination of most toxic exposures.

Top suspects include childhood vaccines, the 10 chemicals listed earlier (glyphosate in particular), autoimmune antibodies, gut inflammation, retroviruses and EMF exposure. To this list, I would also add the COVID gene transfer injections, as they can be a source of severe inflammation and autoimmunity, and have been shown to have a direct adverse impact on neurology.

Posted in Acetaminophen, Autism, Glyphosate, Gut, Mitochondria, Paracetamol, Supplements, Toxins, Vaccinations, Vitamins | One Comment »