Though the Berkeley newsletter, which at its peak reached a million subscribers, did much to establish the credibility of wellness in the ’80s, language pundits continued to raise their eyebrows. Newman, who also moonlighted as a usage commentator, belittled wellness, calling it an example of “bloating” in the language. In 1988, a survey of the Usage Panel for the American Heritage Dictionary of the English Language found that a whopping 68 percent of panelists disapproved of the word when used to refer to employee-wellness programs and the like, and a critical note was included in the dictionary’s 1992 edition.
Insulin serves as a “key” to open your cells, to allow the glucose to enter -- and allow you to use the glucose for energy.  Without insulin, there is no “key.”   So, the sugar stays -- and builds up-- in the blood. The result: the body’s cells starve from the lack of glucose.  And, if left untreated, the high level of “blood sugar” can damage eyes, kidneys, nerves, and the heart, and can also lead to coma and death. 
Type 1 diabetes is commonly called “juvenile diabetes” because it tends to develop at a younger age, typically before a person turns 20 years old. Type 1 diabetes is an autoimmune disease where the immune system attacks the insulin-producing beta cells in the pancreas. The damage to the pancreatic cells leads to a reduced ability or complete inability to create insulin. Some of the common causes that trigger this autoimmune response may include a virus, genetically modified organisms, heavy metals, vaccines, or foods like wheat, cow’s milk and soy. (4)
In type 2 diabetes, there also is a steady decline of beta cells that adds to the process of elevated blood sugars. Essentially, if someone is resistant to insulin, the body can, to some degree, increase production of insulin and overcome the level of resistance. After time, if production decreases and insulin cannot be released as vigorously, hyperglycemia develops.
The term "diabetes" or "to pass through" was first used in 230 BCE by the Greek Apollonius of Memphis.[108] The disease was considered rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career.[108] This is possibly due to the diet and lifestyle of the ancients, or because the clinical symptoms were observed during the advanced stage of the disease. Galen named the disease "diarrhea of the urine" (diarrhea urinosa).[110]

It could have been confused for a sermon had he not been dressed in black-leather pants and cursed so much. And like many people, he’s not exactly aligned with Alcoholics Anonymous’s religious tone and bent, and so he has rewritten the 12 steps in more colloquial terms for anyone who wants to change, whether the addiction is to “eating badly or to bad jobs or to pornography.” Brand’s own 12 steps, projected on a slide, are:—Are you a bit fucked?
Type 1 diabetes is caused by an autoimmune reaction (the body attacks itself by mistake) that stops your body from making insulin. About 5% of the people who have diabetes have type 1. Symptoms of type 1 diabetes often develop quickly. It’s usually diagnosed in children, teens, and young adults. If you have type 1 diabetes, you’ll need to take insulin every day to survive. Currently, no one knows how to prevent type 1 diabetes.

In patients with type 2 diabetes, stress, infection, and medications (such as corticosteroids) can also lead to severely elevated blood sugar levels. Accompanied by dehydration, severe blood sugar elevation in patients with type 2 diabetes can lead to an increase in blood osmolality (hyperosmolar state). This condition can worsen and lead to coma (hyperosmolar coma). A hyperosmolar coma usually occurs in elderly patients with type 2 diabetes. Like diabetic ketoacidosis, a hyperosmolar coma is a medical emergency. Immediate treatment with intravenous fluid and insulin is important in reversing the hyperosmolar state. Unlike patients with type 1 diabetes, patients with type 2 diabetes do not generally develop ketoacidosis solely on the basis of their diabetes. Since in general, type 2 diabetes occurs in an older population, concomitant medical conditions are more likely to be present, and these patients may actually be sicker overall. The complication and death rates from hyperosmolar coma is thus higher than in diabetic ketoacidosis.
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn't make enough insulin. In the past three decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025.
Type 1 diabetes occurs because the insulin-producing cells of the pancreas (beta cells) are damaged. In type 1 diabetes, the pancreas makes little or no insulin, so sugar cannot get into the body's cells for use as energy. People with type 1 diabetes must use insulin injections to control their blood glucose. Type 1 is the most common form of diabetes in people who are under age 30, but it can occur at any age. Ten percent of people with diabetes are diagnosed with type 1.

The results of his medical tests are still being analyzed, Darkes said, but he hasn't needed insulin injections for a year and a half. "It took a long time to sink in," he noted. But Darkes is confident he no longer has type 1 diabetes. He said that doctors told him that he has a "rare" gene that somehow facilitated his cure. "I'm the only one who carries [the gene], at the moment," and there's no further explanation so far, he said.
Conventional cow’s milk: Conventional cow’s milk and dairy products should be eliminated, especially for people with type 1 diabetes. Dairy can be a fantastic food for balancing blood sugar if it comes from goat’s, sheep or A2 cows. But stay away from all other forms of dairy because the A1 casein produced by conventional cows will harm the body and trigger an immune response similar to gluten. When buying dairy, only purchase raw and organic products from pasture-raised animals.
In 2003, ephedrine -- also known as ma huang -- became the first herbal stimulant ever banned by the FDA. It was a popular component of over-the-counter weight loss drugs. Ephedrine had some benefits, but it could cause far more harm, especially in high doses: insomnia (difficulty falling and staying asleep), high blood pressure, glaucoma, and urinary retention. This herbal supplement has also been associated with numerous cases of stroke.
14 November 2018. On World Diabetes Day 2018, WHO joins partners around the world to highlight the impact diabetes has on families and the role of family members in supporting prevention, early diagnosis and good management of diabetes. More than 400 million people live with diabetes worldwide, and the prevalence is predicted to continue rising if current trends prevail. Diabetes is a major cause of premature dying, blindness, kidney failure, heart attack, stroke and lower limb amputation. It was the seventh leading cause of death in 2016.
^ Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CD, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J (June 2010). "Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies". Lancet. 375 (9733): 2215–22. doi:10.1016/S0140-6736(10)60484-9. PMC 2904878. PMID 20609967.

Kidney damage from diabetes is called diabetic nephropathy. The onset of kidney disease and its progression is extremely variable. Initially, diseased small blood vessels in the kidneys cause the leakage of protein in the urine. Later on, the kidneys lose their ability to cleanse and filter blood. The accumulation of toxic waste products in the blood leads to the need for dialysis. Dialysis involves using a machine that serves the function of the kidney by filtering and cleaning the blood. In patients who do not want to undergo chronic dialysis, kidney transplantation can be considered.
Without insulin, that extra sugar starts to hang out in your blood with nowhere to go. Just like with honey or sweet syrup, high concentrations of sugar causes the blood to thicken. Physiologically, this pulls fluids and water from other parts of the body into the bloodstream, causing swelling and dryness. Early symptoms of diabetes are relatively mild, including excessive peeing, dry mouth, itchy skin, hunger, fatigue, and blurred vision.

Type 2 diabetes is by far the most common form (around 90% of all cases) and the one which is increasing the most. It primarily affects overweight people in middle age or later. It’s not uncommon for the affected person to also have a high blood pressure and an abnormal lipid profile. Gestational diabetes is a temporary special case of type 2 diabetes.


Also known as smart insulin, Professor John Fossey at the University of Birmingham is developing this type of insulin delivery system which is designed to circulate in the body, inactive, until blood glucose levels start to rise. As they do, the insulin goes to work to bring these levels back down, ensuring perfect glucose control throughout any given day.
The same thing applies to the chronic back and leg pain so many people have. There may be a few pain signals coming up from tired muscles or joints toward the brain. Those signals go through nerve centers called “pain gates.” Those “gates” are where the signals are mixed with other sense data, feelings, and body states such as tension. In people with chronic pain, the gates amplify the signals over and over until the pain is severe. They do this because the brain thinks the person needs to be warned away from a real threat, such as taking a hand out of the fire so it doesn’t burn.
Endocrinology is the specialty of medicine that deals with hormone disturbances, and both endocrinologists and pediatric endocrinologists manage patients with diabetes. People with diabetes may also be treated by family medicine or internal medicine specialists. When complications arise, people with diabetes may be treated by other specialists, including neurologists, gastroenterologists, ophthalmologists, surgeons, cardiologists, or others.
The emphatic takeaway is that the opposite of addiction is connection. Beating the disease is fundamentally about preempting the point where you lose the freedom to choose: Don’t hold the drink in your hand; don’t go to the party where you know exactly what will go down. In the moment before the bad decision, Brand urged, “you have to make the commitment to call someone who can be your North Star. Someone who is not spellbound in that moment. Someone who can tell you the problem you’re trying to escape is still going to be there, and it’s not going to work, and you’re gonna feel like shit afterward. This is why we need people further down the path, so they can hold our shit as we grow.”
Acupuncture is a procedure where a practitioner inserts very thin needles into specific points on your skin. Some scientists say that acupuncture triggers the release of the body's natural painkillers. Acupuncture has been shown to offer relief from chronic pain and is sometimes used by people with neuropathy, the painful nerve damage that can happen with diabetes.
Currently, people with diabetes who receive a transplanted pancreas (typically not possible unless you are also having a kidney transplant) or who receive islet-cell transplants as part of a research study in the US must take these drugs so that their own body won’t attack the new cells. The drugs work, but raise risk for bacterial and viral infections as well as for mouth sores, nausea, diarrhea, high cholesterol, high blood pressure, fatigue and even some cancers.

A whole range of issues start to crop up when diabetes is left untreated. Excess sugar in the blood can lead to more persistent yeast infections (yeast love sugar). High blood sugar can also affect blood flow, which leads to slower healing for sores and wounds. Over time, the condition can lead to Peripheral Artery Disease (PAD), which causes blood vessels to narrow, lending to a condition called peripheral neuropathy that results in a person not feeling pain. And without a sense of pain after an injury or development of an ulcer, the patient may not realize the wound is progressing – amputation may even be required to save him or her from sepsis.
Without insulin, that extra sugar starts to hang out in your blood with nowhere to go. Just like with honey or sweet syrup, high concentrations of sugar causes the blood to thicken. Physiologically, this pulls fluids and water from other parts of the body into the bloodstream, causing swelling and dryness. Early symptoms of diabetes are relatively mild, including excessive peeing, dry mouth, itchy skin, hunger, fatigue, and blurred vision.

Without insulin, that extra sugar starts to hang out in your blood with nowhere to go. Just like with honey or sweet syrup, high concentrations of sugar causes the blood to thicken. Physiologically, this pulls fluids and water from other parts of the body into the bloodstream, causing swelling and dryness. Early symptoms of diabetes are relatively mild, including excessive peeing, dry mouth, itchy skin, hunger, fatigue, and blurred vision.


Type I diabetes usually occurs in people who are below the age 20 and that is why it is also called as juvenile diabetes. In this type, the body becomes partially or completely unable to produce insulin. Type I diabetes is an autoimmune disease. In this, your immune system attacks the pancreas from where the insulin is produced, thereby making the pancreas inefficient or unable to produce insulin. Type I diabetes cannot be prevented, it can only be controlled with healthy lifestyle changes.

"What is interesting is that some patients retain beta cell function for over 50 years," he said. "And, it seems if you retain some, that's a lot better." So, for Darkes to still have some functioning beta cells would not be impossible, but it wouldn't eliminate the disease, Von Herrath said. "Depending on how many beta cells he has, maybe his form of type 1 diabetes was not very severe."


In type 2 diabetes the body has an increasingly harder time to handle all the sugar in the blood. Large amounts of the blood sugar-lowering hormone insulin are produced, but it’s still not enough, as insulin sensitivity decreases. At the time of being diagnosed with type 2 diabetes, diabetics usually have ten times more insulin in their bodies than normal. As a side effect, this insulin stores fat and causes weight gain, something that has often been in progress for many years before the disease was diagnosed.

^ Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, Rosenson RS, Williams CD, Wilson PW, Kirkman MS (June 2010). "Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation". Diabetes Care. 33 (6): 1395–402. doi:10.2337/dc10-0555. PMC 2875463. PMID 20508233.
Many usage guides have disparaged preventative as improper, because it doesn't accord with classical roots: the Latin past participle stem praevent- adds -ion to form prevention and -ive to form preventive. Words ending in -ative ought to have the -at- in the root already: demonstrat- begets demonstration and demonstrative, narrat- begets narration and narrative, and so forth. Since we don't have preventation, then preventative is equally misbegotten, by this way of thinking.
2018 was a year whose realities sometimes seemed to approach the dystopias and dramas of fiction, as stories of family trauma, environmental disaster, and sexual assault played out on the world stage. The books our writers and editors were drawn to this year include many that illuminate these struggles and inequities, whether in the form of visceral sonnets, lyrical history, or dizzyingly surreal detective yarns. But they also reach past political themes to the most intimate and universal of stories: a cross-continental meditation on transitory love, a warm and funny account of aging, a timeless reinvention of an ancient myth, and an absorbing deconstruction of faith, to name a few. Our list isn’t definitive or comprehensive, but guided by individual interests and tastes. Below, you’ll find essays, poetry, three striking fiction debuts, the first graphic novel to be longlisted for the Man Booker Prize, and more.
The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, defines complementary and alternative medicine as a "group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." Complementary medicine is used with conventional treatments, whereas alternative medicine is used instead of conventional medicine.
English word formation isn't always that tidy, however. The -ative ending often shows up even when there isn't a corresponding noun ending in -ation: we have authoritative without authoritation, qualitative without qualitation and talkative without talkation. Talk, of course, isn't even from Latin, but the friendly -ative suffix clung to it anyway, by analogy with other verbs that form adjectives by appending -ative, like affirm and affirmative, or represent and representative. Preventative got created from prevent by this same analogical pattern.
Home blood sugar (glucose) testing is an important part of controlling blood sugar. One important goal of diabetes treatment is to keep the blood glucose levels near the normal range of 70 to 120 mg/dl before meals and under 140 mg/dl at two hours after eating. Blood glucose levels are usually tested before and after meals, and at bedtime. The blood sugar level is typically determined by pricking a fingertip with a lancing device and applying the blood to a glucose meter, which reads the value. There are many meters on the market, for example, Accu-Check Advantage, One Touch Ultra, Sure Step and Freestyle. Each meter has its own advantages and disadvantages (some use less blood, some have a larger digital readout, some take a shorter time to give you results, etc.). The test results are then used to help patients make adjustments in medications, diets, and physical activities.
The WHO estimates that diabetes mellitus resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death.[9][101] However another 2.2 million deaths worldwide were attributable to high blood glucose and the increased risks of cardiovascular disease and other associated complications (e.g. kidney failure), which often lead to premature death and are often listed as the underlying cause on death certificates rather than diabetes.[101][104] For example, in 2014, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.9 million deaths worldwide,[19] using modeling to estimate the total number of deaths that could be directly or indirectly attributed to diabetes.[20]

Vanadium is a compound found in tiny amounts in plants and animals. Early studies showed that vanadium normalized blood sugar levels in animals with type 1 and type 2 diabetes. When people with diabetes were given vanadium, they had a modest increase in insulin sensitivity and were able to lower their need for insulin. Researchers want to understand how vanadium works in the body, find potential side effects, and set safe dosages.

The diabetes market is expected to reach a massively big €86Bn by 2025 combining both type 1 (€32Bn) and type 2 (€54Bn) treatments, and we can expect all sort of revolutionary technologies to come forward and claim their market share. Researchers are already speculating about microchips that can diagnose diabetes type 1 before the symptoms appear or nanorobots traveling in the bloodstream while they measure glucose and deliver insulin.
When 69-year-old Sandi, of Houston, was diagnosed with type 2 diabetes in 2007, she was confident she’d be able to manage the disease well. “I felt like, ‘I have this handled, it will be great,’” she recalls. Yet after the death of her best friend, five years ago, she started to experience anxiety and depression, and, she says, “it started manifesting more with my diabetes.”
Talk to your doctor before using treatments based on capsaicin. It can cause allergic reactions, interact with other drugs, or cause dangerous side effects on open sores and irritated or sensitive skin. It might also make you more sensitive to the sun and other sources of heat. Avoid excessive exposure to sunlight or heat when using capsaicin creams or lotions.

Diarrhea and constipation may also stem from diabetes-related gut movement issues. And the conditions may be related. “Diarrhea doesn’t mean fast motion; constipation doesn’t mean slow movement,” says Mashimo, happy to clear up a common misconception. “They can be two sides of the same coin.” Constipation, he says, is caused by slow movement of the bowels, which can cause a buildup of harmful bacteria in the colon that, in turn, triggers diarrhea. 
In autoimmune diseases, such as type 1 diabetes, the immune system mistakenly manufactures antibodies and inflammatory cells that are directed against and cause damage to patients' own body tissues. In persons with type 1 diabetes, the beta cells of the pancreas, which are responsible for insulin production, are attacked by the misdirected immune system. It is believed that the tendency to develop abnormal antibodies in type 1 diabetes is, in part, genetically inherited, though the details are not fully understood.
In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised.
Christina Kalberg is the Executive Director of the Diabetes Research Connection (DRC). She comes to DRC with over 10 years of experience as a senior-level executive effectively integrating passion and in-depth skill into well-crafted marketing, public relations, communications, operations and fundraising campaigns to directly fuel multi-million-dollar revenue growth. Christina is a strategist, deftly aligning staff and other stakeholders. She has a Bachelor’s degree in Journalism with an emphasis in Public Relations and a Master’s degree in Business Administration. Christina is also an adjunct professor for the marketing program at Point Loma Nazarene University, where she teaches Digital and Social Media Marketing.
Diabetes is the major cause of blindness, kidney failure, heart attack and stroke. The number of people affected by all types of diabetic disorders is now over four times higher than just 40 years ago. This has led the World Health Organization (WHO) to consider diabetes an epidemic, predicting it will soon be the seventh biggest cause of death worldwide.
Triglycerides are a common form of fat that we digest. Triglycerides are the main ingredient in animal fats and vegetable oils. Elevated levels of triglycerides are a risk factor for heart disease, heart attack, stroke, fatty liver disease, and pancreatitis. Elevated levels of triglycerides are also associated with diseases like diabetes, kidney disease, and medications (for example, diuretics, birth control pills, and beta blockers). Dietary changes, and medication if necessary can help lower triglyceride blood levels.
People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT) or insulin resistance. People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Each year, 1% to 5% of people whose test results show impaired glucose tolerance actually eventually develop diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such as metformin (Glucophage), to help prevent/delay the onset of overt diabetes.
Benari, an Ashkenazi Jew, doesn’t fall into that category. But Cummings and other bariatric experts I spoke to said that surgery should be a possible option for any person whose diabetes isn’t improving. Cummings himself is currently working on a clinical trial in India of bariatric patients with BMIs as low as 25. And he expects similar trials will come down the pipeline.
Your thoughts can affect pain severity. In wartime, soldiers’ wounds often are less painful than the same wounds would be in a civilian. Why? Because the wounds signify that the wounded soldier will soon be going home, but the civilian’s injury is a source of fear and anxiety. This is known as the “Anzio effect” after the World War II battle that took place near Anzio, Italy, where it was first noted.

Disclaimer: The entire contents of this website are based upon the opinions of Dr. Mercola, unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Mercola and his community. Dr. Mercola encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional. If you are pregnant, nursing, taking medication, or have a medical condition, consult your health care professional before using products based on this content.


The fact these improvements can happen independently of weight loss should also signify a shift in how we conceptualize both obesity and diabetes, according to Peter Billings, the Seattle bariatric surgeon who operated on Benari. Billings, a nearly 20-year veteran in the field, has started to perform surgery on other lower-BMI patients similar to Benari, though they often pay out of pocket.
In addition to the problems with an increase in insulin resistance, the release of insulin by the pancreas may also be defective and suboptimal. In fact, there is a known steady decline in beta cell production of insulin in type 2 diabetes that contributes to worsening glucose control. (This is a major factor for many patients with type 2 diabetes who ultimately require insulin therapy.) Finally, the liver in these patients continues to produce glucose through a process called gluconeogenesis despite elevated glucose levels. The control of gluconeogenesis becomes compromised.

People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT) or insulin resistance. People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Each year, 1% to 5% of people whose test results show impaired glucose tolerance actually eventually develop diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such as metformin (Glucophage), to help prevent/delay the onset of overt diabetes.
These diabetes complications are related to blood vessel diseases and are generally classified into small vessel disease, such as those involving the eyes, kidneys and nerves (microvascular disease), and large vessel disease involving the heart and blood vessels (macrovascular disease). Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels, leading to coronary heart disease (angina or heart attack), strokes, and pain in the lower extremities because of lack of blood supply (claudication).
Lab studies show that Encellin’s “ultra thin-film implantable cell delivery system” keeps islet cells alive and functioning. In a 2015 study in the journal ACS Nano, Dr. Nyitray and others found that cells in the packaging survived for 90 days in lab animals. New blood vessels grew around the transplants and the cells produced insulin in response to rising glucose levels. In a 2016 study from Dr. Desai’s lab, also published in ACS Nano, human islet cells packaged in the tiny film envelopes survived for six months in mice—and the cells made and released insulin in response to rising blood glucose levels.

^ Santaguida PL, Balion C, Hunt D, Morrison K, Gerstein H, Raina P, Booker L, Yazdi H. "Diagnosis, Prognosis, and Treatment of Impaired Glucose Tolerance and Impaired Fasting Glucose". Summary of Evidence Report/Technology Assessment, No. 128. Agency for Healthcare Research and Quality. Archived from the original on 16 September 2008. Retrieved 20 July 2008.
As of 2015, an estimated 415 million people had diabetes worldwide,[8] with type 2 DM making up about 90% of the cases.[16][17] This represents 8.3% of the adult population,[17] with equal rates in both women and men.[18] As of 2014, trends suggested the rate would continue to rise.[19] Diabetes at least doubles a person's risk of early death.[2] From 2012 to 2015, approximately 1.5 to 5.0 million deaths each year resulted from diabetes.[8][9] The global economic cost of diabetes in 2014 was estimated to be US$612 billion.[20] In the United States, diabetes cost $245 billion in 2012.[21]
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