Food-Focused Media Literacy for Remotely Acculturating Adolescents and Mothers: A Randomized Controlled Trial of the "JUS Media? Programme".

PURPOSE: Unhealthy eating is a major modifiable risk factor for noncommunicable diseases and obesity, and remote acculturation to U.S. culture is a recently identified cultural determinant of unhealthy eating among adolescents and families in low/middle-income countries. This small-scale randomized controlled trial evaluated the efficacy of the "JUS Media? Programme," a food-focused media literacy intervention promoting healthier eating among remotely acculturating adolescents and mothers in Jamaica. METHODS: Gender-stratified randomization of 184 eligible early adolescents and mothers in Kingston, Jamaica (i.e., 92 dyads: Madolescent.age = 12.79 years, 51% girls) determined 31 "Workshops-Only" dyads, 30 "Workshops + SMS/texting" dyads, and 31 "No-Intervention-Control" dyads. Nutrition knowledge (food group knowledge), nutrition attitudes (stage of nutritional change), and nutrition behavior (24-hour recall) were primary outcomes assessed at four time points (T1/baseline, T2, T3, T4) across 5 months using repeated measures analysis of covariances. RESULTS: Compared to control, families in one or both intervention groups demonstrated significantly higher nutrition knowledge (T3 adolescents, T4 mothers: mean differences .79-1.08 on a 0-6 scale, 95% confidence interval [CI] .12-1.95, Cohen's ds = .438-.630); were more prepared to eat fruit daily (T3 adolescents and mothers: .36-.41 on a 1-5 scale, 95% CI .02-.77, ds = .431-.493); and were eating more cooked vegetables (T4 adolescents and T2 and T4 mothers: .20-.26 on a 0-1 scale, 95% CI -.03-.50, ds = .406-.607). Postintervention focus groups (6-month-delay) revealed major positive impacts on participants' health and lives more broadly. CONCLUSIONS: A food-focused media literacy intervention for remotely acculturating adolescents and mothers can improve nutrition. Replication in Jamaica and extension to the Jamaican diaspora would be useful.

U.S. Media Enjoyment without Strong Media Literacy Undermines Adolescents' and Mothers' Reported Efforts to Reduce Unhealthy Eating in Jamaica.

We investigate whether media literacy and media use can moderate the association between U.S. media enjoyment and unhealthy eating among remotely acculturating "Americanized" adolescents and their mothers in Jamaica (n = 164 individuals/82 dyads; Madolescent.age  = 12.83, SD = 0.48, 48% female; Mmother_age  = 39.25, SD = 5.71). Socioeconomically diverse participants completed questionnaires reporting their degree of enjoyment of U.S. media (i.e., remote acculturation), media literacy (i.e., critical thinking about food media/advertising), and adherence to national dietary guidelines to reduce sugar/fat. Multilevel modeling showed that enjoying U.S. media and consuming high levels of U.S. TV plus Jamaican TV are associated with lower efforts to reduce sugar and fat. However, high media literacy, whether one's own or a close family member's, weakens or nullifies that association.

Transdisciplinary team science for global health: Case study of the JUS Media? Programme.

The world's most pressing health problems, such as the childhood obesity pandemic, demand creative new solutions. In this article it is argued that psychological theories, concepts, and methods are ripe for integration with those of other disciplines to synthesize innovative transdisciplinary global health solutions. As a model, the process of blending developmental and cross-cultural psychology with health and media sciences to develop a transdisciplinary intervention for youth and families in Jamaica-the J(amaican and) U(nited) S(tates) Media? Programme-is described. Jamaicans on the island are being inundated by the inflow of U.S. media, and those who have internalized U.S. culture and become "Americanized" via a process called remote acculturation are especially vulnerable to negative health habits promoted by U.S. media and advertising. In response, the JUS Media? Programme teaches critical thinking skills about food advertising (especially U.S.-produced) to decrease unhealthy eating among Americanized youth and families in Jamaica. In this article, first, transdisciplinarity is defined and distinguished from other scientific orientations (uni-, multi-, and interdisciplinarity) using the evolution of scholarship within JUS Media? Programme's transdisciplinary team as an example. Next, the application of transdisciplinary team science to global health problems is explained. As an example, the guiding transdisciplinary model for the JUS Media? Programme is described, and the cultural adaptation process used to design the JUS Media? Programme for Jamaican families is detailed. Finally, there is a reflection on best practices for transdisciplinary team leadership and collaboration. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Association of Vitamin D Levels With Outcome in Patients With Melanoma After Adjustment For C-Reactive Protein.

PURPOSE: To evaluate for an association between 25-hydroxyvitamin D levels (vitamin D) and outcome measures in patients with melanoma after evaluation is controlled for systemic inflammatory response (SIR) on the basis of simultaneous C-reactive protein (CRP) measurement. MATERIALS AND METHODS: Plasma samples from 1,042 prospectively observed patients with melanoma were assayed for vitamin D and CRP. The associations of demographics and CRP with vitamin D were determined, followed by a determination of the association between vitamin D and stage and outcome measures from the date of blood draw. The vitamin D level was considered sufficient if it was 30 to 100 ng/mL. Kaplan-Meier and Cox regression analyses were performed. RESULTS: The median vitamin D level was 25.0 ng/mL. The median follow-up time was 7.1 years. A lower vitamin D was associated with the blood draw during fall/winter months (P < .001), older age (P = .001), increased CRP (P < .001), increased tumor thickness (P < .001), ulcerated tumor (P = .0105), and advanced melanoma stage (P = .0024). On univariate analysis, lower vitamin D was associated with poorer overall (OS; P < .001), melanoma-specific survival (MSS; P = .0025), and disease-free survival (DFS; P = .0466). The effect of vitamin D on these outcome measures persisted after adjustment for CRP and other covariates. Multivariable hazards ratios per unit decrease of vitamin D were 1.02 for OS (95% CI, 1.01 to 1.04; P = .0051), 1.02 for MSS (95% CI, 1.00 to 1.04; P = .048), and 1.02 for DFS (95% CI, 1.00 to 1.04; P = .0427). CONCLUSION: Lower vitamin D levels in patients with melanoma were associated with poorer outcomes. Although lower vitamin D was strongly associated with higher CRP, the associations of lower vitamin D with poorer OS, MSS, and DFS were independent of this association. Investigation of mechanisms responsible for these associations may be of value to patients with melanoma.

C-reactive protein as a marker of melanoma progression.

PURPOSE: To investigate the association between blood levels of C-reactive protein (CRP) in patients with melanoma and overall survival (OS), melanoma-specific survival (MSS), and disease-free survival. PATIENTS AND METHODS: Two independent sets of plasma samples from a total of 1,144 patients with melanoma (587 initial and 557 confirmatory) were available for CRP determination. Kaplan-Meier method and Cox regression were used to evaluate the relationship between CRP and clinical outcome. Among 115 patients who underwent sequential blood draws, we evaluated the relationship between change in disease status and change in CRP using nonparametric tests. RESULTS: Elevated CRP level was associated with poorer OS and MSS in the initial, confirmatory, and combined data sets (combined data set: OS hazard ratio, 1.44 per unit increase of logarithmic CRP; 95% CI, 1.30 to 1.59; P < .001; MSS hazard ratio, 1.51 per unit increase of logarithmic CRP; 95% CI, 1.36 to 1.68; P < .001). These findings persisted after multivariable adjustment. As compared with CRP < 10 mg/L, CRP ≥ 10 mg/L conferred poorer OS in patients with any-stage, stage I/II, or stage III/IV disease and poorer disease-free survival in those with stage I/II disease. In patients who underwent sequential evaluation of CRP, an association was identified between an increase in CRP and melanoma disease progression. CONCLUSION: CRP is an independent prognostic marker in patients with melanoma. CRP measurement should be considered for incorporation into prospective studies of outcome in patients with melanoma and clinical trials of systemic therapies for those with melanoma.

Genome-wide association study identifies novel loci predisposing to cutaneous melanoma.

We performed a multistage genome-wide association study of melanoma. In a discovery cohort of 1804 melanoma cases and 1026 controls, we identified loci at chromosomes 15q13.1 (HERC2/OCA2 region) and 16q24.3 (MC1R) regions that reached genome-wide significance within this study and also found strong evidence for genetic effects on susceptibility to melanoma from markers on chromosome 9p21.3 in the p16/ARF region and on chromosome 1q21.3 (ARNT/LASS2/ANXA9 region). The most significant single-nucleotide polymorphisms (SNPs) in the 15q13.1 locus (rs1129038 and rs12913832) lie within a genomic region that has profound effects on eye and skin color; notably, 50% of variability in eye color is associated with variation in the SNP rs12913832. Because eye and skin colors vary across European populations, we further evaluated the associations of the significant SNPs after carefully adjusting for European substructure. We also evaluated the top 10 most significant SNPs by using data from three other genome-wide scans. Additional in silico data provided replication of the findings from the most significant region on chromosome 1q21.3 rs7412746 (P = 6 × 10(-10)). Together, these data identified several candidate genes for additional studies to identify causal variants predisposing to increased risk for developing melanoma.

Inequality in early childhood: risk and protective factors for early child development.

Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children's risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world's poorest children and reduce persistent inequalities.

Zinc supplementation and psychosocial stimulation: effects on the development of undernourished Jamaican children.

BACKGROUND: Undernourished children have poor levels of development that benefit from stimulation. Zinc deficiency is prevalent in undernourished children and may contribute to their poor development. OBJECTIVE: We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children. DESIGN: This was a randomized controlled trial with 4 groups: stimulation alone, zinc supplementation alone, both interventions, and control (routine care only). Subjects were 114 children aged 9-30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics. Clinics were randomly assigned to receive stimulation or not; individual children were randomly assigned to receive zinc or placebo. The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged. The supplementation was 10 mg Zn as sulfate daily or placebo. Development (assessed by use of the Griffiths Mental Development Scales), length, and weight were measured at baseline and 6 mo later. Weekly morbidity histories were taken. RESULTS: Significant interactions were found between zinc supplementation and stimulation. Zinc benefited the developmental quotient only in children who received stimulation, and benefits from zinc to hand and eye coordination were greater in stimulated children. Zinc supplementation alone improved hand and eye coordination, and stimulation alone benefited the developmental quotient, hearing and speech, and performance. Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth. CONCLUSION: Zinc supplementation benefits development in undernourished children, and the benefits are enhanced if stimulation is also provided.

Presence of Anorexia Nervosa and Bulimia Nervosa in Jamaica

We could find no previous data describing the extent to which eating disorders are a public health problem in Jamaica, and so we carried out two exercises to assess this. We investigated the number of cases of anorexia nervosa (AN) and bulimia nervosa (BN) presenting at the University Hospital of the West Indies (UHWI) between 1985 and 1988, using case records, and carried out a survey among health professionals (psychiatrists, clinical psychologists, paediatricians and nutritionists/dietitians) to determine the number of patients with eating disorders seen by them between 1996 and 1998. We also examined the diagnostic criteria used and correlates of eating disorders. Only two cases of AN were treated at UHWI. Eleven cases each of AN and BN (two males) had presented to the health professionals surveyed, chiefly the psychiatrists. The AN patients ranged in age from 14 to 28 years (mean 20.9 years), and the BN patients from 11 to 35 years (mean 22.2 years). Eating disorders were reported primarily among urban dwellers (76 percent), and half of the cases were among students. Limiting food intake, excessive exercise and vomiting were the most frequently used metdods of weight control. Nine eating disorder patients (41 percent) were also diagnosed with depression, and five (23 percent) patients reported previous emotional trauma. The occurrence of eating disorders in Jamaica appears to be very low. (AU)

Concepts of obesity among outpatients of a Jamaican hospital

Obesity is an important risk factor for the development of chronic non-communicable diseases such as diabetes and hypertension, which affects large numbers of Caribbean people. There is a perception that Caribbean culture is not only tolerant of obesity but actually encourages this state, especially among women. We carried out a survey among normal-weight and overweight adults in order to investigate their attitudes to obesity. Three hundred adults (245 women and 55 men) present at the Casualty department at the University Hospital during the study period were asked to participate. A questionnaire was given, and heights and weights were measured to determine Body Mass Index (BMI). The relation between BMI and attitudes to obesity was explored. Forty percent of the respondents agreed that fatness was a sign of happiness, 15 percent thought it represented wealth, and 10 percent thought it represented health. Just over half (58 percent) of the women who were overweight perceived themselves to be fat, while of the overweight men (42 percent) thought themselves fat. Fifty-six percent of the men, and 38 percent of the women preferred a slim partner. Most respondents were aware of the diseases associated with obesity and could name foods which contributed to obesity e.g. fried foods and sweets. These data suggest that obesity is viewed favourably, or not unfavourably, by nearly half of the sample, or the converse, over half of the respondents did not view obesity favourably. Although the problems of obesity are recognized, overweight people are not necessarily aware that they are in fact overweight and at risk. Health promotion efforts should take this into account. (AU)

Concepts of obesity among outpatients of a Jamaican hospital

Obesity is an important risk factor for the development of chronic non-communicable diseases such as diabetes and hypertension, which affects large numbers of Caribbean people. There is a perception that Caribbean culture is not only tolerant of obesity but actually encourages this state, especially among women. We carried out a survey among normal-weight and overweight adults in order to investigate their attitudes to obesity. Three hundred adults (245 women and 55 men) present at the Casualty department at the University Hospital during the study period were asked to participate. A questionnaire was given, and heights and weights were measured to determine Body Mass Index (BMI). The relation between BMI and attitudes to obesity was explored. Forty percent of the respondents agreed that fatness was a sign of happiness, 15 percent thought it represented wealth, and 10 percent thought it represented health. Just over half (58 percent) of the women who were overweight perceived themselves to be fat, while of the overweight men (42 percent) thought themselves fat. Fifty-six percent of the men, and 38 percent of the women preferred a slim partner. Most respondents were aware of the diseases associated with obesity and could name foods which contributed to obesity e.g. fried foods and sweets. These data suggest that obesity is viewed favourably, or not unfavourably, by nearly half of the sample, or the converse, over half of the respondents did not view obesity favourably. Although the problems of obesity are recognized, overweight people are not necessarily aware that they are in fact overweight and at risk. Health promotion efforts should take this into account.

The use of herbal teas and remedies in Jamaica

We investigated the prevalence of the use of herbs among adults and children in Jamaica in 1996. Two concurrent surveys were conducted in randomly selected urban and rural area; among the adults and among caretakers of young children. From over 90 percent of the selected households, all caretakers of children under 6 years and one randomly selected adult (18 years or older) were interviewed using structured questionnaires. The 457 adults reportedly used 156 types of herbs: a mean of 6ñ3 (mean ñ standard deviation) by the urban adults, and 10ñ6 by the rural adults (t-test, p < 0.001). Almost 100 percent of respondents had at some time used herbs for teas or for treating illnesses. The most common methods of preparation was by infusion or boiling in water, then adding sugar. Urban respondents, women and those who were employed were more likely to buy medicines than to use herbal remedies. One hundred and sixty-seven caretakers of 203 children under 6 years were interviewed. The mean number of herbs given to each child was between 2 and 3. The most common herbs were introduced within the first 6 months of life. Many caretakers factors were associated with herbal use. Public health implications include the potential toxicity of some herbs, the possibilty that herbal teas given to young children may displace more nutritious foods and delay presentation to health care facilities. The findings will allow policy makers to target those most likely to use herbal preparations or to give them to young children, and target herbs to be analyzed for toxic or beneficial properties.(Au)

Behaviour and development of stunted and nonstunted Jamaican children

In order to examine the mechanism whereby stunted children have poor developmental levels, we compared the behaviour of stunted (N = 78) and nonstunted (N = 26) children aged 12 to 24 months, and examined the relationship of their behaviour to their developmental levels. The effect of nutritional supplementation with or without psychosocial stimulation on the stunted children's behaviour was also examined. The children were observed at home during 4 days over a period of 6 months. The children significantly showed more apathy, and less enthusiasm and variety in exploring, were less happy and more fussy. Caretakers' vocalisations to them were less warm or instructive. Stunted children's activity level, exploratory and happy behaviours were predictive of change in developmental levels measured on the Griffiths Scales, from enrolment to 12 and 24 months later. Supplementation predicted mental age at 12 and 24 months later enrolment, however, it had no significant effect on behaviour (Au)

Zinc supplementation, morbidity and growth in stunted Jamaican children

We investigated whether there was a morbidity or growth response to zinc supplementation of nutrition clinic attenders in Kingston, which would indicate zinc deficiency. Children selected were singletons aged 6 to 24 months and stunted (<2.0 sd length for age, NCHS references). They were stratified by gender and age (6-11, 12-17, 18-24 mo.) and randomly assigned to receive zinc supplementation (n=31) (5mg elemental zinc), or placebo (n=30) daily for 12 weeks. Adequately nourished comparison children (n=24) were recruited from a well-baby clinic. Caretakers were interviewed to obtain social background data. Anthropometric measurements were done on enrolment and after 6 weeks, 12 weeks and 12 months. A weekly questionnaire to determine the stunted children's health was given to the caretakers during the supplementation period. The zinc supplemented and placebo groups were very similar on enrolment. The adequately nourished children were significantly better socio-economic circumstances. Five placebo children, but no zinc supplemented children, were hospitalized during the supplemented period (Fisher's exact test, two-tailed, p=0.02), indicating reduced severity of illness with supplementation, which suggests a response to zinc deficiency. There were no significant differences in hair zinc content among the three groups. Regression analyses showed that there were no significant effects of supplementation of length, height or head circumference, or on the incidence of any symptom. Mean duration of the episodes were significantly shorter for skin rashes in the supplemented group compared with the placebo group (ANCOVA, P=0.02), and longer for vomiting (ANCOVA, p=0.02).(AU)

A case-control study of aggressive and pro-social Jamaican school boys

We examined the correlates of behaviour of 102 aggressive and 103 pro-social boys, selected by peer and teacher ratings, from grades 5 and 6 in 10 primary schools in urban Kingston and St. Andrew. The children were given in-depth questionnaires, school achievement test (WRAT) and verbal ability tests (Peabody Picture Vocabulary Test). Their parents were also given questionnaires. Interobserver and test retest reliabilities were established for all questionnaires and tests. Interviewers were unaware of the boys' groups. The aggressive group was significantly older (mean 11.1 years; t-test p<0.1). The aggressive group had significantly lower scores on both the number of possessions and the housing rating (proxies for socio-economic status); they showed significantly lower scores on spelling, arithmetic, reading and verbal IQ, and considered themselves less bright than the pro-social boys. Preliminary analyses indicate that, as expected, the aggressive boys fought more and used knives more compared with the pro-social boys. They reported receiving significantly more punishment at home. The aggressive group indicated that they saw significantly more family fights. All differences remained significant when socio-economic status was controlled in analyses of covariance except that the difference in the arithmetic scores was no longer significant. Many of these patterns are similar to those reported elsewhere.(AU)

Zinc supplementation: effects on the growth and morbidity of undernourished Jamaican children

OBJECTIVE: We investigated whether there was a growth or morbidity response to zinc supplementation. DESIGN: The study was randomized, placebo-controlled, and double-blind. SETTING: Children were recruited at clinics in Kingston, Jamaica, and supplemented at home. SUBJECTS: Children selected were singletons aged 6-24 months, and stunted (< -2.0 s.d. length for age, NCHS references). They were stratified by sex and age and randomly assigned to receive zinc supplement (n = 31) or placebo (n = 30). Four children were excluded because of hospitalization; all others had all measurements. Adequately nourished children (n = 24) were recruited from a well-baby clinic. INTERVENTIONS: The supplement provided 5 mg elemental zinc in a syrup daily for 12 weeks; the placebo comprised the syrup only. MAIN OUTCOME MEASURES: Caretakers were interviewed to obtain social background data, number of clinic visits and hospitalizations. Anthropometric measurements were done on enrolment, and after 6 weeks, 12 weeks and 12 months. Children's health was determined by weekly questionnaire to caretakers of the undernourished groups during the supplementation period. RESULTS: The supplemented and placebo groups were similar on enrolment. The adequately nourished children were from significantly better socio-economic circumstances. Mean initial hair zinc content was 5.5 +/- 4.8 mumol/g (supplemented group) and 6.7 +/1 12.1 mumol/g (placebo) (n.s.). Regression analyses showed that there were no significant effects of supplementation on length, height or head circumference, nor on the incidence of any morbidity symptom. Mean duration of the episodes was significantly shorter for skin rashes in the supplemented group compared with the control group (ANCOVA, P = 0.02), and longer for vomiting (P = 0.02). The incidence of hospitalization was significantly greater in the control group (Fisher's exact test, P = 0.02). CONCLUSIONS: Zinc supplementation reduced the hospitalizations which probably reflect severity of morbidity, but did not improve growth.(Au)

A case-control study of aggressive and pro-social Jamaican school boys

The study examined the correlates of behavior of 102 aggressive and 103 prosocial boys, selected by peer and teacher ratings, from grades 5 and 6 in 10 schools in urban Kingston and St. Andrew. The children were given in-depth questionnaires, school achievement tests (WRAT) and verbal ability tests (Peabody Picture Vocabulary Test). Their parents were also given questionnaires. Interobserver and test-retest reliabilities were established for all questionnaires and tests. Interviewers were unaware of the boys' group. The aggressive group was significantly older (mean 11.4 years) than the pro-social boys (mean 11.1 years; t-test p,0.01). The aggressive group had significantly lower scores on both the number of possessions and the housing rating (proxies for socio-economic status), they showed significantly lower scores on spelling, arithmetic, reading and verbal IQ, and considered themselves less bright than the pro-social boys. Preliminary analyses indicate that, as expected, the aggressive boys fought more and used knives in fights more compared with the pro-social boys. They reported receiving significantly more punishments at home. The aggressive group indicated that they saw significantly more family quarrels, threats between family members and family fights. All differences remained significant when socio-economic status was controlled in analyses of covariance except that the differences in the arithmetic scores was no longer significant. Many of these patterns are similar to those reported elsewhere. (AU)

Activity levels and maternal-child behavior in undernutrition: studies in Jamaica

It has been well established that children suffering from severe or moderate protein energy malnutrition in early childhood show delayed development, but the mechanisms linking undernutrition to poor development are not well understood. One holds that undernutrition causes irreversible central nervous system changes that affect function... The authors have recently reviewed, in detail, studies on activity and undernutrition n children. This work will briefly review the literature on activity levels and behavior in undernourished children and then describe two Jamaican studies that addresses aspects of the functional isolation hypothesis. Activity levels will be discussed first, then, other behaviors

A case-control study of aggressive and pro-social Jamaican school boys

The study examined the correlates of behaviour of 102 aggressive and 103 prosocial boys, selected by peer and teacher ratings, from grades 5 and 6 in 10 schools in urban Kingston and St. Andrew. The children were given in-depth questionnaires, school achievement tests (WRAT) and verbal ability tests (Peabody Picture Vocabulary Test). Their parents were also given questionnaires. Interobserver and test-retest reliabilities were established for all questionnaires and tests. Interviewers were unaware of the boys' group. The aggressive group was significantly older (mean 11.4 years) than the pro-social boys (mean 11.1 years; t-test p,0.01). The aggressive group had significantly lower scores on both the number of possessions and the housing rating (proxies for socio-economic status), they showed significantly lower scores on spelling, arithmetic, reading and verbal IQ, and considered themselves less bright than the pro-social boys. Preliminary analyses indicate that, as expected, the aggressive boys fought more and used knives in fights more compared with the pro-social boys. They reported receiving significantly more punishments at home. The aggressive group indicated that they saw significantly more family quarrels, threats between family members and family fights. All differences remained significant when socio-economic status was controlled in analyses of covariance except that the differences in the arithmetic scores was no longer significant. Many of these patterns are similar to those reported elsewhere.