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Many factors are contributing to the rise of early onset puberty in girls. Learn what they are below and how you can support your daughter. The number of girls experiencing early puberty has increased dramatically over the last few years and continues to grow. More and more girls in the U.S. are starting to show signs of development before the age of 8. Recent studies show that up to 10 percent of Caucasian girls and 23 percent of African American girls are showing signs of puberty by age 7. What’s Contributing to Early Puberty in Girls? Determining the exact cause is difficult. But experts agree that several factors may be contributing to these growing numbers. Increasing rates of childhood overweight and obesity. Excess body fat alters the levels of hormones responsible for the acceleration of pubertal timing. Physical inactivity may decrease melatonin levels, which can also trigger pubertal development. Increased animal protein intake. Higher total protein, animal protein and meat intake in children ages 3 to 7 have been associated with earlier onset of menstruation. High protein intake elevates IGF-1 levels and promotes growth, which could accelerate the onset of puberty. Poor diet. Children with lower-nutrient diets tend to enter puberty earlier. A diet rich in processed foods and meats, dairy, and fast food is disruptive to normal physical development. Exposure to EDCs (endocrine-disrupting chemicals). EDCs are synthetic chemicals found in plastics, pesticides, fuels and other industrial chemicals that inhibit or alter the action of natural hormones. Because EDCs accumulate in the fatty tissues of animals, animal foods contain higher levels of these chemicals than plant foods. Exposure to BPA (bisphenol A). BPA is an industrial petrochemical found in a variety of products including plastics, tin-can linings and even cash register receipts. Because it acts as a synthetic estrogen it may speed up pubertal development. Soy products. Soy contain isoflavones which are converted to phytoestregens in the body, and are similar to the hormone estrogen, Dr. Chelsea Wicks says. “Soy consumed from natural food sources is likely safe and will not cause abnormal hormones levels. However, when consumed in large amounts, such as with soy supplements or in more processed foods, there have been links to chronic medical problems due to elevated estrogen levels. I feel a good answer to this is to continue working on eating fresh foods and trying to avoid the processed, packaged foods as this will be best for overall general nutrition as well,” she adds. What You Can Do While some genetic factors play a role in the early onset of puberty, parents can help lessen environmental causes of the condition. Encourage and help your child to maintain a healthy weight with proper nutrition and exercise. Avoid exposure to hormones such as estrogen and testosterone that may be found in hair products, medications and nutritional supplements. Avoid exposure to EDCs and BPA. Offer your child a diet centered around whole plant foods rather than animal foods, which will help keep protein intake within a safe range and reduce consumption of EDCs. Create a supportive environment for your daughter. Avoid commenting on her appearance and instead focus on her achievements, academic successes or artistic talents. Speak to her openly and honestly about the physical changes she’s experiencing — that although these changes are normal, she’s simply developing early — and that ultimately her peers will undergo the same changes. Encourage your daughter to continue participating in social activities and pursuing her interests, and reassure her you are always open to discuss any questions or worries. If you are concerned that your child may be going through these changes before expected, speak with your pediatrician. Sources: Early Puberty: Causes and Consequences When Is Puberty Too Early? Precocious Puberty (Early Puberty) Precocious Puberty

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An arthritis diagnosis doesn’t mean your exercise routine has to end. In fact, a consistent routine can actually improve mobility. Although stiff and painful joints can make it difficult to keep moving, staying active is essential for easing pain. October 11 is World Arthritis Day, so we asked Michelle Higgins, MPT at Renown Physical Therapy & Rehab some advice about exercising with arthritis. According to the Arthritis Foundation, arthritis affects one in five adults and 300,000 children. As a matter of fact arthritis is the nation’s leading cause of disability. Your joints certainly don’t need to suffer when you exercise. In general exercise is actually necessary for those with arthritis. Not only does it reduce joint pain, but it also increases strength and flexibility. Furthermore those adopting a regular exercise routine also have more energy, deeper sleep and find it easier to maintain a healthy weight. “Exercise is a necessary component to managing your arthritis,” says Higgins. “Consistent participation in an exercise program has been shown to promote long-term pain relief, increased body function and an improved quality of life. Alternatively, a lack of exercise can actually increase joint pain or stiffness and eventually lead to long term disability and suffering.” Exercising With Arthritis Exercise truly is the most effective non-drug arthritis treatment available for reducing pain and improving movement. And it can even include daily activities like gardening, dancing or walking your dog. Of course talk to your doctor or physical therapist about what exercises fit into your specific treatment plan. With this is mind, the four specific components below are important to an effective arthritis exercise program: Range of motion Moving joints through their full available range of movement is important. This frequently increases function and decreases joint stiffness and pain. For this reason, aim to complete these exercises daily. Examples include bending, straightening, and rotating specific joints, or static and dynamic stretching. Strengthening These exercises target muscles supporting and protecting our joints and bones. Strengthening is also necessary for weight control, so two-to-three sessions per week are recommended. In order to allow your body to adapt, begin with light resistance and start slow. Strength exercises include weightlifting and using resistance bands. Low-impact aerobic exercise Aerobic exercise is certainly necessary for overall well-being, weight management and heart health. Aim for two-to-three sessions a week. Low-impact exercises include walking, swimming, cycling, elliptical machine exercises and water aerobics. Balance Good balance is also vital for an effective arthritis program. On the positive side, solid balance prevents falls by increasing your ability to stay upright whether you are moving or sitting still. Likewise, it improves your confidence with walking and daily activities. In order to keep excellent balance, incorporate daily balance exercises. Examples of balance exercises include the use of an exercise ball, Tai Chi and exercises such as standing on one foot. Start Slow, Finish Strong As you begin your exercise program, remember to listen to your body. Start slowly – it can take several weeks for your body to adjust to exercise. Consult your doctor, or physical therapist, if you experience increasing pain or swelling which doesn’t go away with rest. Above all, incorporate fun and motivating activities so you’ll stick to them long term and improve your results. Renown Physical Therapy & Rehab 775-982-5001 Through outpatient physical, occupational and speech therapy, Renown Physical Therapy & Rehab gives you hands-on, individualized treatment in convenient Reno/Sparks locations. We have the latest, most advanced physical therapy and rehab equipment, specialty services and treatments. Renown Physical Therapy & Rehab is now open on Robb Drive in addition to three additional locations in Reno and Sparks. Call 775-982-5001 or visit us online.

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Winter skin alert – cold temperatures can put your skin into chaos. We asked for skin tips from Heidi Nicol, an esthetician with Renown Dermatology, Laser & Skin Care. She shares how to keep your skin glowing through the frosty months ahead. With the change from warm to cold weather, your skin can get stressed out. In fact, issues like flaky skin, irritation and chapped lips can be an everyday struggle. 5 Easy Winter Skincare Tips 1. Re-think your shower Few things feel better on a cold day than a long, hot shower. But hot showers can lead to dry skin because they strip your skin of its natural protective oils. Avoiding them altogether is best – choose a lukewarm, or warm, shower instead. If you have an occasional hot shower, the American Academy of Dermatology (AAD) suggests keeping it at five to ten minutes. Nicol recommends using a gentle cleanser and avoid using too much. Moisturizing after a shower or bath while your skin is still damp is also a must. Slathering on your favorite lotion helps your skin hold on to precious moisture. 2. Stay away from smoke and fire Although sitting close to a roaring fireplace can feel good, it is drying to your skin. Smoking and exposure to smoke also harms your skin. Smoking reduces healthy blood flow to the skin. This also causes your skin to wrinkle faster, making you looker older. Additionally your skin heals much slower if you smoke. 3. Consider a humidifier Cranking up the thermostat dries out indoor air. Skin is our largest organ, and in general, heat is very drying to your skin. To clarify, over time dry air degrades your skin’s natural moisture (lipid) barrier leading to flaking, peeling and cracking. Your skin can overcompensate for the dryness by producing even more oil. In other words it is possible for your skin to be both oily and dehydrated at the same time. Even oily skin needs a daily lightweight, non-pore clogging moisturizer. 4. Use SPF daily The sun’s rays damage your skin even on cloudy days. Sunlight contains UVB (burning) and UVA (aging) rays. Although UVB rays are less strong in the winter, the UVA rays are same strength all year. And snow can reflect almost 90% of UV radiation. With this in mind make sure you have suitable skin and eye protection when going outdoors. 5. Take care of your hands and feet Don’t forget your fingers and toes when moisturizing. These areas tend to be drier than other parts of the body. Gloves help to protect hands from winter weather and lock in moisture. Similarly, putting lotion on your feet before your socks will keep them your skin from flaking and cracking. Follow the tips above to make sure your skin is at its best, despite the winter weather. Renown Dermatology, Laser & Skin Care | 775-982-8255 Renown Dermatology, Laser & Skin Care offers a comprehensive range of treatments and products to address any skin care need. Visit our beautiful office in south Reno and browse our product lines. Experts are available to answer any questions concerning your skin care and health and wellness needs.

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Dr. Max J. Coppes, Physician-in-Chief Renown Children’s Hospital, and Nell J. Redfield Chair of Pediatrics, UNR Med, talks about how much is too much when it comes to teens and social media. Social apps (Facebook, Instagram, Twitter, WhatsApp, Snapchat, TikTok, etc.) have become an integral part of most people’s lives. In contrast to traditional media — where one source goes to many receivers — social media operates in a dialogic transmission system. Many sources interact, sometimes simultaneously, with many receivers and provide for superior interactivity between its users. Not surprisingly, it also plays a significant role in our children’s lives once they are old enough to understand how to access and use these apps. On average, children start exploring social media at around ages 10 to 12. They rapidly discover that electronic communication allows for unique and personalized ways to make and keep friendships. They also use it to develop and expand family ties, get help with homework, share music, art, and experiences, and learn and discover the world. Social Media and Teens Surveys suggest that more than 90 percent of teenagers use social media. Additionally, approximately 75 percent have at least one active profile by age 17. Access to social media is greatly facilitated because more than two-thirds of teens have their own mobile devices with internet capabilities, a substantial change relative to previous generations. The use of social apps can have many positive aspects. But we now also recognize that it can also have negative impacts. The use of hazardous sites or the inherent risks of using social media (identity theft, being hacked, cyber-bullying, etc.) are indeed damaging to children. Any use of hazardous social apps is too much and carries serious hazards. But what about the use of “normal” and/or “safe” social media? Well, data suggest that too much use of “non-hazardous” apps can indeed affect health. How Much Do Teens Use Social Media? First, some basic data. For example, how much do normal teenagers use social media? A study from Pew Research found that more than 50 percent of 13- to 17 year-olds go online several times a day. This quickly increases during the teenage years to more than 70 minutes per day. Teenage girls have the highest usage at just over 140 minutes per day. It is important to recognize that non-school related use of the internet and social media is often beheld by teenagers as important for developing their self-esteem, their acceptance among peers, and their mental health in general. As parents, we recognize that the use of social media can indeed contribute, in many positive ways, to our children’s growth. At the same time, we also worry about them spending too much time online. We worry about their ability to communicate effectively in face-to-face settings or in writing. Many of us also feel and/or worry that our children are addicted. Social Media and Addiction Recent studies suggests that the overuse of social media indeed mirrors addiction. Reports now show that teenagers and college kids experience anxiety when deprived from their connected devices and consequently feel a compulsion to access their social applications. The emotional symptoms they experience are very similar to those seen in substance abuse. In fact, the American Psychiatric Association is considering making internet addition a bonafide diagnosis. Pediatricians therefore encourage limits on the use of social media, a recommendation more easily suggested than accomplished. So when should a parent consider seeking help? Aside from unhealthy use of these apps (cyber-bullying, sexting, online users asking for sexual relations, etc.), which should always trigger concern, the use of social media for more than 120 minutes per day should trigger parental concern. If you feel unable to address the overuse of social media, contact your pediatrician for help and guidance. Renown Children’s Hospital Whether it’s seeing a pediatrician, getting a sports physical or looking for advice, our care is centered around supporting and nurturing patients and families at our many locations. We have pediatricians dedicated to children who have experience recognizing children’s illnesses. They also have knowledge about tests and treatments for young ones to ensure your child gets the best care possible. Explore Children’s Services

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Did you know that your makeup brushes are likely full of built-up dirt and bacteria? Using dirty makeup tools can lead to irritation, breakouts and even infections. The good news? It's completely preventable. An expert explains For anyone who regularly wears makeup, brushes are great tools for powdering, contouring and finishing touches. Unfortunately, these same brushes also harbor harmful bacteria that can clog pores and cause unwanted breakouts. “Brush hairs and sponges are porous, and hold on to oils, debris and bacteria,” says Heidi Nicole, medical esthetician with Renown Dermatology, Laser & Skin Care. “Also, if they are dirty, the application of makeup can be spotty and make blending more difficult." Most dermatologists suggest that you clean your makeup brushes at least once a week. Because they are used on your face, it makes sense to keep them as a clean as possible. In addition, your brushes will last longer if you stay on top of cleaning them. Six simple steps to integrate makeup brush care into your beauty routine: Wet your brush with lukewarm water. (Don’t soak your brushes, as water in the brush barrel can cause the hairs to fall out.) Place a drop of gentle cleanser or specialized brush cleaner in the palm of your hand. Gently massage the tips of the bristles on your palm. Rinse the bristles well. Blot with a clean towel and reshape the head. Let the bristles dry over the edge of a counter. Do not allow the bristles to dry on the towel, which could cause the brush to mildew. Store your brushes in a clean, dry place in between uses.

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If you’re a parent, you’ve probably been there — the sometimes-nightly struggle to get your little ones off to bed. Elaina Lantrip, an APRN with Renown Pediatrics, offers some tips and explains how your child’s electronics may be getting in the way of a good night’s sleep. These days, kids are consuming media from a very early age on all types of devices — from tablets and phones to TVs. While they can benefit from some media use, it can have a negative impact on bedtime. We asked Elaina Lantrip, an advanced nurse practitioner with Renown Pediatrics, for some advice on downloading a better bedtime routine. What are the most important practices for parents to establish for their children’s bedtime routines? I often have parents tell me that their child won’t go to bed — or to sleep. Parents frequently ask for tips on bedtime routines that work. My first question is whether their regular bedtime routine involves television, iPad, tablet, phone or anything with a screen. It’s very important that bedtime includes a bath, reading a story, talking, singing and bonding with young ones, rather than using any devices. Why shouldn’t children have a device at bedtime? A growing body of research supports that screen time at bedtime contributes to delays in a child’s falling to sleep; overall inability to reach the important REM, or deep sleep; waking up during the night; nightmares and night terrors. For older youth, engaging with social media before bedtime can bring up stresses, emotions and relationship issues with peers that don’t exactly create peaceful bedtime thoughts. Bedtime should be a screen-free, stress-free, peaceful time of day. It’s a great time for parents to promote self-esteem, talk through things going on in the child’s life, to encourage and build them up. Children grow up fast — bedtime is a great the opportunity with younger children to cuddle up and read a story or sing a lullaby. What are other major considerations in making bedtime smooth and relaxing for kids and their parents? Another factor that contributes to positive sleep habits includes children getting enough activity during the the day so they’re genuinely tired at night. Also helpful are ambient noise makers, peaceful music, avoiding sugar two hours prior to bedtime, consistency in bedtime routine, comfortable pajamas and comfortable temperature in the home. Is it important to keep the child’s bedroom dark? Dimming the lights is important, regardless of the time of year. This is another reason to ban screens, as they emit light that stimulates wakefulness.

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Immunizations (vaccines) save the lives of thousands of children and adults annually, protecting us from illnesses that can lead to disease, hospital stays, life-long complications and even death. Not only do immunizations protect the persons receiving the vaccine, but through herd immunity, vaccines protect children that are unable to get vaccines due to illness or age and our elderly community members whose immunities may have declined. Vanessa Slots, M.D., offers insight on the importance of immunizations. Immunizations Your Child Needs (and when) Birth to 6 Months Hepatitis B: Shortly after birth, first vaccine dose Diphtheria, Tetanus, and Pertussis (DTaP), Polio, Haemophilus Influenza (HiB), Pneumonia, Hepatitis B and Rotavirus: Ages 2, 4 and 6 months, boosters and vaccines One Year to 18 Months MMR and Varicella (chickenpox) vaccine: Age 1, first vaccine dose Hepatitis A, HiB and Pneumonia: Age 1, booster DTaP: 15 months, fourth vaccine dose Hepatitis, second dose: 18 months Flu Vaccine: 6 months and older, annually* *In the year after receiving their first dose, an infant will need a booster one month later. Four Years Old MMRV, DTaP and Polio, final dose: Four years of age Pre-Teen and Beyond Tdap and Meningitis: Before starting middle school, children receive these vaccines. They are also old enough to start the HPV vaccine, an essential vaccine for all young adults to protect against cancer, genital warts and cervical dysplasia.

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As we begin to enjoy the springtime weather in northern Nevada, are you finding your skin less than tip-top shape? Here’s how to add moisture back in easy, natural ways. You don’t need to be a medical aesthetician: Dry, cold climates can often wreak havoc on your body’s largest organ — your skin. These tips from Renown Dermatology, Laser & Skin Care will quickly put moisture back and relieve dry, chapped skin. 11 Miraculous Moisturizing Tips Always wear broad-spectrum sunscreen, even during winter months. Don’t forget to use an SPF lip balm, too. Heaters dry out your skin. Use a humidifier to keep moisture in the air. (And try these simple tips to make sure you’re keeping that humidifier clean.) If your skin is dehydrated, try using a nighttime moisturizer during the day. Use a hydrating mask or moisturizing mask twice a week. Don’t forget your hands and feet. Apply a rich cream to the hands and feet at night and cover them with gloves and socks to restore moisture while you sleep. Drink plenty of water to stay hydrated. Try adding a hydrating serum to your morning and nighttime skincare routine to heal the skin. Use a gentle exfoliant to remove dry skin at least once a week, which helps your skin absorb your moisturizer. Apply body oil or lotion in the shower while your skin is still damp to trap moisture. Hot water dries out your skin, so turn down the temperature in the shower and bath.   A little pampering goes a long way, and Renown’s medical aestheticians are here to help. Trained in skincare and advanced therapies, our experts can transition your skin to look healthy, youthful and rejuvenated.

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Flu shots don’t just protect those who get vaccinated; they protect everyone, including your family and the community. As we continue navigating the COVID-19 (coronavirus) pandemic, Renown Health infection prevention expert Whitney Robinson explains how getting your flu shot is vital for staying healthy. 5 Ways to Schedule Your Flu Shot Call Us! 775-982-5000 Urgent Care Appointments Renown Pharmacy Vaccinations Make an Appointment via MyChart Need a Doctor? Find One Now Reasons to get the flu shot Chills, body aches, fever, congestion; getting the flu isn’t fun. But in addition to protecting yourself with a flu shot, you’re helping reduce flu cases and hospitalizations, Whitney said. Flu shots are currently available at pharmacies throughout the Reno area. Whitney says the ideal time to get your flu shot is September through October, but remain relevant throughout the winter months as it only takes two weeks for the antibodies to develop in your body. This timing allows the vaccine to provide the strongest protection during the length of flu season. Who needs a flu shot? Almost everyone. The Centers for Disease Control and Prevention recommends the yearly flu shot for everyone six months of age and older. Equally, they consider it the first and most crucial step in protecting against the flu virus.

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You want to protect yourself and your family from the harmful rays of the sun — which are especially punishing at northern Nevada’s higher altitudes — but with so many options, how do you choose the right sunscreen? We asked our expert, Dr. Angela Walker, a dermatologist with Renown Medical Group, to shed some light on the subject. Sunscreen Application Dermatologists recommend a broad-spectrum sunscreen with a minimum SPF of 30, but keep in mind that no sunscreen protects against 100 percent of UV radiation and that reapplication is necessary. “No matter the SPF, sunscreen must be applied adequately and frequently, meaning a quarter-sized amount to cover the face and neck and a full shot glass amount for the body when wearing a bathing suit,” said Walker. “Reapplication should be every 80 minutes.” Why not use a high SPF, such as 70 or 100? According to the Skin Cancer Foundation, they don’t offer significantly more protection than SPF 30 and mislead people into thinking they have a higher level of protection. Here’s the breakdown: SPF 15 blocks 93 percent of UVB rays SPF 30 blocks 97 percent of UVB rays SPF 50 blocks 98 percent of UVB rays SPF 100 blocks 99 percent of UVB rays Do specific populations require a higher SPF? Walker explains that infants, seniors, and those with a history of skin cancer must take precautions against UV radiation, as their skin is vulnerable. Sunscreen should be an absolute priority before spending time outdoors and avoiding prolonged sun exposure, wearing a hat with wide brim (recommended 4-inch brim) and UPF (ultraviolet protection factor) clothing. Due to the sensitive nature of an infant’s skin, babies under six months should not spend time in the direct sun. For infants and toddlers six months and older, whose skin is thinner than adults, a sunscreen that contains zinc oxide or titanium dioxide (physical protectors) should be applied. Zinc and titanium are less likely to irritate because they do not penetrate the skin and instead sit on the surface and deflect UV radiation. Zinc oxide and titanium dioxide are vital ingredients to seek out in sunscreen due to their strong ability to deflect UV radiation. Sunscreen Terms Explained UVA = Long wave ultraviolet light. Penetrates deep into the dermis, the skin’s thickest layer, causing tissue damage that wrinkles and photo-aging and contributes to developing skin cancer. UVB = Short wave ultraviolet light. The biggest contributor to the development of skin cancer and are more prevalent during mid-day. SPF = Sun protection factor. Calculated by comparing the amount of time needed to burn sunscreen-protected skin vs. unprotected skin. So, SPF 15 means you can stay in the sun 15 times longer than you could without protection.

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Want to protect yourself from skin damage from the sun’s harmful rays? Dr. Angela Walker, dermatologist with Renown Medical Group, shares what you can do to prevent skin cancer. What can people do to prevent skin cancer while enjoying the outdoors? There are several steps you can take to protect your skin from the sun. “I caution all of my patients to avoid the sun during the hours of 10 a.m. until 2 p.m. when UV rays are strongest. I also encourage people to wear sleeves on cooler days. And don’t forget that we still need to wear sunscreen on cloudy days! UV rays can still cause sun damage on cloudy days. Preventing skin cancer also entails wearing sunscreen of at least SPF 30 everyday.  Are hats also a good idea for skin protection? Yes, of course! Choose a wide-brim hat that shades the face as well as the back of the neck for extra protection against UV rays. When it comes to identifying skin cancer, what should people watch for? We use easy-to-remember letters when checking for spots on the skin; it’s called the ABCDEs: How often should people go to a dermatologist for a full-body skin check? People with a family history of melanoma or who have already had skin cancer need to be screened at least once a year. Those who are younger and use sunscreen daily don’t need to be seen as regularly. Their primary care provider can do a yearly screening. And remember to do self-screening at home to keep an eye out for unusual looking spots. Is it best to visit a care provider with an expertise in skin with questions or concerns? Absolutely. As a dermatologist, I see a lot of people coming in with a changing mole or brown spot that looks irregular. I can assure them it’s benign or get them the treatment they need. We can even use photography to monitor skin spots and have the patient take photos at home. We also perform biopsies as needed.

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Vanessa Slots, MD, of Renown Medical Group – Pediatrics, explains why getting a flu shot each season can save lives—especially true for the very young and elderly. Why Kids Need Flu Shots The flu is not a passing cold. It is a serious illness that takes lives every year. And this year, flu activity is increasing late in the season.  And it happens like clockwork — the onset of an influenza epidemic as fall transitions into winter, and lasts into the spring months. This acute respiratory illness is caused by influenza A or B viruses with yearly outbreaks occurring worldwide. No one is immune, and everyone is susceptible to the flu. Flu Signs and Symptoms: Abrupt onset of fever Headache Body aches and fatigue along with respiratory-tract symptoms including cough Sore throat and an irritated nose Who’s at Risk? Once again: Everyone is susceptible, but children and the elderly are at greater risk of complication from influenza, specifically toddlers less than 2 years. At this age, immunities are underdeveloped. Seniors over 65 are also at increased risk because their immune systems have weakened with age. The severity of a child’s symptoms depend on age and prior exposure to the virus. And with young children, flu is more problematic, since they cannot verbalize certain symptoms like body aches and headaches. As a result, children often experience higher fevers, which can lead to seizures or convulsions. Coupled with gastrointestinal issues such as nausea, vomiting, diarrhea and poor appetite, children are at risk of dehydration and other complications from the virus that can require hospitalization. In fact, an average of 20,000 children are hospitalized from flu each year. Pre-Existing Health Issues Health conditions, including but not limited to asthma, cystic fibrosis, heart conditions, cerebral palsy, epilepsy or diabetes, can intensify flu symptoms. Still, a substantial number of children with none of these risk factors experience severe complications from the flu. How to Protect Your Child from the Flu The best way to guard against influenza is with a flu shot. Children and adults should get the flu vaccine before flu season kicks in — usually by the end of October. Shots are provided as long as flu viruses are circulating and the vaccine is in supply.

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