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For years, experts have debated what to advise older adults in this situation. Only 27% to 44% of older adults meet these guidelines, according to various surveys. Epidemiologic research suggests that the ideal body mass index (BMI) might be higher for older adults than younger adults. The study’s conclusion: “The WHO healthy weight range may not be suitable for older adults.” Instead, being overweight may be beneficial for older adults, while being notably thin can be problematic, contributing to the potential for frailty. Indeed, an optimal BMI for older adults may be in the range of 24 to 29, Carl Lavie, a well-known obesity researcher, suggested in a separate study reviewing the evidence surrounding obesity in older adults.
Persons: they’ve, , Mitchell Lazar, we’re, John Batsis, Anne Newman, , Carl Lavie, Lavie, , ” Lavie, Newman, you’re, Dinesh Edem, Dennis Kerrigan, Katie Dodd Organizations: CNN, US Centers for Disease Control, Institute for Diabetes, University, Pennsylvania’s Perelman, of Medicine, University of North Carolina School of Medicine, Center for Aging, Health, University of Pittsburgh School of Public Health, BMI, World Health Organization, WHO, University of Pittsburgh, University of North, University of Arkansas, Medical Sciences, Henry Ford Health, Kaiser Health, KFF Locations: , Chapel Hill, New Orleans, University of North Carolina, Michigan
Investors had been banking on the study results being the next big driver of the company's shares. That's due to high demand and after Novo raised its profit outlook in April, said Berenberg analyst Kerry Holford. If the risk reduction was between 10 and 14%, shares would decrease by less than 5%. A year ago, investors said a risk reduction of 10 to 14% in the trial would put significant downward pressure on the stock, Holford said. Barclays analyst Emily Field said a risk reduction as low as 11% could boost the stock.
Persons: Novo, Kerry Holford, Holford, Emily Field, Maggie Fick, Josephine Mason, Alexandra Hudson Organizations: Soaring U.S, Novo Nordisk's, Nestle, UBS, Reuters, Barclays, May, BMO Global Asset Management, Alexandra Hudson Our, Thomson Locations: Danish, United States
Tom Schroeder, the whistleblower accusing Medtronic of a kickback scheme, left, is interviewed by Morgan Brennan, in Kansas City, Missouri. Schroeder said rumors circulated that Medtronic sales representatives were bribing VA staff to purchase an excessive amount of the company's inventory. The veterans hospital purchased more devices than some of the largest veterans medical facilities, according to data the VA's investigation gathered. Medtronic also said that Schroeder has "admitted under oath that he has no firsthand knowledge of any problematic procedure involving Medtronic devices." Douglas Winger, one of the Medtronic sales representatives named as a defendant in Schroeder's lawsuit, won a Medtronic President's Club award in 2016 for his sales.
Persons: Tom Schroeder, Schroeder, Becton Dickinson, Medtronic, Morgan Brennan, Schroder, Boua Xiong, Robert J, texted, Rick Ament, Ament, filet mignon, , I'm, Brendan Donelon, Donelon, CNBC Donelon, Xiong, Douglas Winger, Winger, Kim Hodgson, Hodgson, Dole, ProPublica, John Laird Organizations: Inc, CNBC, Dole Veterans Affairs Medical Center, Dole VA, Department of Veterans Affairs, United, VA's, Department of Justice, Covidien, Dole, Medtronic, Society for Vascular, Drug Administration, FDA Locations: Kansas, United States, Kansas City , Missouri, Dublin, Ireland, Medtronic's, Wichita ., Dole, Covidien, Medtronic, Dole VA
Morgan Stanley upgrades Shockwave Medical to overweight from equal weight Morgan Stanley said shares of the cardiovascular medical device company are well positioned. Jefferies reiterates Tesla as hold Jefferies raised its price target on Tesla to $265 per shar from $185 but said it's standing by its hold rating. UBS reiterates Disney as buy UBS said it's cautious heading into Disney earnings in early August, but it's sticking with its buy rating. Morgan Stanley reiterates Netflix as equal weight Morgan Stanley raised its price target on the stock to $450 per share from $350 and said the risk/reward for Netflix is balanced. Morgan Stanley reiterates Rivian as overweight Morgan Stanley said it's standing by its buy rating on the electric vehicle company. "
Persons: Estee Lauder, Wells, Fox, Morgan Stanley, Goldman Sachs, Goldman, Charles Schwab, JMP, Schwab, KBW, it's, Jefferies, Tesla, JPMorgan, Rivian, Stifel, Oppenheimer Organizations: Citi, Estee Lauder Citi, Fox News, Nvidia, company's Data, Bank of America, UBS, Disney, Netflix, Cava, JPMorgan, Apple, Weyerhaeuser, of America, Brands, Bell, KFC Locations: BlackRock, Amazon's, GMV, CAVA
CNN —Amid the raging war and constant threat of Russian missiles, a successful heart transplant has been performed on a 6-year-old girl in Kyiv, authorities with the Heart Institute of Ukraine’s Ministry of Health announced on Monday. It was the first time a heart transplant had been performed in Ukraine on children so young, the institute said. “The operation went smoothly, the girl was extubated two hours after the operation,” Todurov said in a post on his official Facebook page. Ukrainian Transplant Coordination CenterThe Heart Institute released images from the operation showing the mother of the boy whose heart was donated standing by the girl’s bedside. The Heart Institute has purchased special generators so operations can continue during blackouts, and it has an autonomous water supply.
Persons: CNN —, Dr, Boris Todurov, ” Todurov, Oksana Dmytrieva, ” Dmytrieva, , , hasn’t Organizations: CNN, Heart Institute of Ukraine’s Ministry of Health, Heart Institute, Transplant Coordination, Ukrainian, Facebook, National Children’s Locations: Russian, Kyiv, Ukraine, Kherson region, Kirovohrad
Wall Street is underestimating the opportunity for a cardiovascular medical device company's core product to penetrate the market, according to Morgan Stanley. Analyst Patrick Wood upgraded shares of Shockwave Medical to overweight from in-line, saying the Street is misjudging the potential catalysts that could improve the sales outlook for its coronary IVL catheter used before stent implantation, and that consensus expectations look "too low." Given this setup, Wood lifted his price target to $335 a share, reflecting 28% upside from Friday's close. SWAV YTD mountain Share performance in 2023 Potential catalysts for Shockwave shares include an investor day, a favorable environment for medical technology and an extended timeline before it faces new competition, Wood said. "We think recent coronary reimbursement improvements from CMS mean the market is underestimating the penetration opportunity over the coming 2-3 years," Wood wrote.
Persons: Morgan Stanley, Patrick Wood, Wood, — CNBC's Michael Bloom Organizations: Shockwave, Centers, Medicare, Medicaid
Hong Kong CNN —US drugmaker Moderna has signed a deal to make mRNA medicines in China as part of its first major investment in the country, despite escalating trade and political tension between Washington and Beijing. The company currently only markets its mRNA vaccines for Covid-19, but has a number of vaccines and therapeutics in its pipeline. Those focus on addressing infectious diseases, immuno-oncology, rare diseases, cardiovascular diseases and autoimmune diseases, according to the company. Moderna’s Covid-19 vaccine, which received emergency authorization from US regulators in 2020 and full approval in 2022, has not been approved in China. For most of the pandemic, China relied on more traditional platforms for its homegrown Covid-19 vaccines.
Persons: Yicai, Janet Yellen, Biden, Moderna’s, Johnson Organizations: Hong Kong CNN, CNN, Xinhua, CSPC Pharmaceutical Group, Pfizer Locations: Hong Kong, China, Washington, Beijing, The Cambridge , Massachusetts, Shanghai’s Minhang, Shijiazhuang
In addition to total cholesterol, the study tracked triglycerides, a type of fat that comes from butter and oils; low-density lipoprotein cholesterol, also known as LDL or “bad” cholesterol; and high-density lipoprotein cholesterol, known as HDL or ‘good’ cholesterol. In the Neurology study, variations in LDL and HDL cholesterol weren’t associated with higher risk for Alzheimer’s disease or related dementias. Lipids and neurodegenerative diseaseThe authors found a link, but not a causal relationship, between fluctuating levels of cholesterol and triglycerides and risk of Alzheimer’s disease and related dementias. Exactly how varying lipid levels and risk for Alzheimer’s or related dementias are related remains unclear, Bielinski said. “Always consult your doctor or healthcare provider if you are concerned about your cardiovascular health, cholesterol levels, or cognitive decline,” Weber said via email.
Persons: , Christopher Weber, Suzette J, Bielinski, hadn’t, ” Bielinski, ” Weber, , Weber Organizations: CNN, Alzheimer’s Association, Mayo Clinic, Neurology Locations: Minnesota
CNN —Being overweight as defined by the body mass index rating scale is not linked to an increase in death when considered separately from other health issues, a new study found. “The use of the word ‘overweight’ is misleading here, as it excludes anyone with a BMI above 30. “This paper found an unequivocal association between BMI and mortality, before and after adjustment for risk factors,” said Leurent, who was not involved in the study. Being overweight may not lead to an early death, but may add to the risk of chronic disease, experts say. While the study did control for smoking and a variety of other diseases linked to early death, that information was only gathered once for each person in the survey.
Persons: , Aayush, Rutgers Robert Wood, , Baptiste Leurent, Leurent, Robert H, Shmerling, , Soko, Visaria, Naveed Sattar, ” Sattar, Tom Sanders, Beth, they’ve, It’s, ” Visaria, it’s, University of Glasgow’s Sattar Organizations: CNN, BMI, US Centers for Disease Control, Rutgers, Rutgers Robert Wood Johnson Medical School, University College London, Harvard Health Publishing, Harvard Medical School, Rutgers School of Public Health, University of Glasgow, King’s College London, Beth Israel Deaconess Medical, , American Heart Association, American Medical Association, University of Glasgow’s Locations: New Brunswick , New Jersey, Boston, Scotland,
CNN —If TikTok and Reddit influencers are to be believed, the plant-based compound called berberine can be a replacement for such popular diabetes and weight loss drugs as Ozempic and Wegovy. Is berberine’s weight loss effect meaningful? Berberine may enhance the body’s natural production of GLP-1, or glucagon-like peptide 1, a gastrointestinal hormone that’s used in Ozempic and other new weight loss drugs. However, in terms of its weight loss benefits, they are modest at best,” he said. “Metformin lowers blood sugar, and berberine lowers blood sugar,” Levitt said.
Persons: Berberine, , , Caroline Apovian, Justin Ryder, Ryder, Joshua Levitt, Ashurbanipal, ” Levitt, Gaston Ernesto Gonzalez Avila, Levitt Organizations: CNN, US Food and Drug Administration, Harvard Medical School, Center, Weight Management, Wellness, Brigham, Women’s Hospital, Northwestern University’s Feinberg School of Medicine, BMI, National Library of Medicine, FDA, American Chemical Society Locations: Boston, Chicago, Ayurveda, Hamden , Connecticut
Wegovy was approved as an obesity treatment in June 2021 , but Ozempic, a Type 2 diabetes treatment, has been used off-label for weight loss. Mounjaro uses GLP-1 and gastric inhibitory polypeptide, or GIP, to help patients lose weight. Eli Lilly's oral drug, orforglipron, has an even better profile . They also could be helpful in assisting patients in maintaining weight loss after they've used the injectable versions, he said. Some have highlighted that oral drugs also may be more manageable for patients who can't handle the idea of giving themselves a once-a-week injection.
Persons: Eli Lilly, we're, Jonathan Wolleben, Wegovy, Lilly's tirzepatide, It's, Mounjaro, Wolleben, Eli Lilly's tirzepatide, Lilly, , Novo, Eli, it's, they've, FactSet, Altimmune's pemvidutide, Morgan Stanley, Mark Purcell, Purcell, Graig Suvannavejh, Suvannavejh, Roth, Dylan Dupuis, Dupuis, Trung Huynh, Goldman Sachs, Chris Shibutani, Shibutani Organizations: Novo Nordisk, JMP Securities, Citizens Company, Nordisk's Ozempic, Food and Drug Administration, Nordisk, Novo, Zealand Pharma, Shandong Suncadia, GSBR, Biosciences, Fujian Shengdi Pharmaceutical, Mizuho Securities, Terns Pharmaceuticals, American Diabetes Association, Viking Therapeutics, Pfizer, Credit Suisse, AstraZeneca, Therapeutics, Medicare, Medicaid, CNBC Pro's Locations: Danish, Shandong, Fujian, Viking
Texas heat is not letting up at night
  + stars: | 2023-06-29 | by ( Evan Bush | ) www.cnbc.com   time to read: +3 min
The heat wave in Texas has offered little reprieve. Heat at night disrupts sleep and prevents the body from recovering and cooling down, making minimum temperatures a critical indicator of a heat wave's severity, experts said. Texas State Climatologist John Nielsen-Gammon said temperatures during this heat wave in the state have threatened records at both ends of the spectrum — including maximums and minimums — in its urban centers. Ebi said the high nighttime temperatures and the prolonged nature of the Texas heat wave are particularly concerning. "A very small percentage of death certificates during a heat wave put down, 'heat' as an underlying cause," Ebi, who studies heat deaths, adding that about half of excess deaths, on average, are from cardiovascular diseases.
Persons: Del, Ben Zaitchik, John Nielsen, Gammon, We've, Kristie, Ebi, Everything's, Nielsen, We're Organizations: National Weather Service, Johns Hopkins University, Nielsen, Center for Health, Global, University of Washington Locations: Texas, Del Rio, San Antonio, Houston, Midland, San Angelo
How to stay healthy in hot weather
  + stars: | 2023-06-28 | by ( Katia Hetter | ) edition.cnn.com   time to read: +7 min
And how can everyone prepare for hot weather events outdoors? She previously served as health commissioner of Baltimore, where her duties included overseeing the city’s “Code Red” responses to extreme hot weather. They should seek out resources from their local and state government, which may provide cooling centers and temporary shelters during periods of extreme hot weather. Especially if you live in environments where your children are not used to hot weather, monitor them closely. CNN: How can everyone prepare for hot weather events?
Persons: Leana Wen, Wen, Heatstroke, heatstroke, it’s, don’t Organizations: CNN, George Washington University Milken Institute School of Public Health, US Environmental Protection Agency, Getty Locations: United States, Baltimore
More than 40% of Americans are obese, according to the U.S. Centers for Disease Control and Prevention, and demand is strong for treatments to reduce body weight as well as maintain weight loss. The company said it would continue to develop its twice-daily weight loss drug candidate. Structure Therapeutics (GPCR.O) is developing oral obesity drugs that it says are simpler to manufacture than the current injectables. "We define weight loss quality as the percentage of weight loss attributed to fat loss," said Versanis Chief Scientific Officer Lloyd Klickstein. "With diets, bariatric surgery, incretin drugs or other weight loss drugs, two-thirds to three-quarters of the weight loss is fat, but one-quarter to one-third is lean."
Persons: Robert Gabbay, Eli Lilly, Lilly's, Wegovy, Mico Guevarra, Lilly, Jeff Emmick, Ray Stevens, Boehringer Ingelheim, Versanis, Lloyd Klickstein, Chaguturu, Deena Beasley, Michele Gershberg, Jamie Freed Organizations: DIEGO, Novo Nordisk's, American Diabetes Association, Novo, U.S . Centers for Disease Control, ADA, Pfizer, Therapeutics, Zealand Pharma, Novartis, CVS Health, Aetna, Thomson Locations: San Diego, GLP
[1/3] The International Space Station (ISS) is photographed by Expedition 66 crew member Roscosmos cosmonaut Pyotr Dubrov from the Soyuz MS-19 spacecraft, in this image released April 20, 2022. "A weaker immunity increases the risk of infectious diseases limiting astronauts' ability to perform their very demanding work in space. Gene expression in 247 genes in leukocytes was at about one third the normal levels while in space, the study found. Before this paper, we knew of immune dysfunction but not of the mechanisms," said study co-author Guy Trudel, an Ottawa Hospital rehabilitation medicine specialist. Discovering altered gene behavior in leukocytes is "a significant step toward understanding human immune dysregulation in space," Trudel added.
Persons: Pyotr Dubrov, Odette Laneuville, Guy Trudel, Trudel, Epstein, Barr, Will Dunham, Rosalba O'Brien Organizations: Space, Expedition, Soyuz, REUTERS, WASHINGTON, University of Ottawa, Canadian Space Agency, NASA, Ottawa Hospital, Thomson Locations: Handout, Canada, Ottawa
Americans are clamoring for new weight-loss drugs, but companies aren't rushing to pay for them. At most, half of US employers help pay for weight-loss drugs for their workers, according to several estimates. "The drug companies, providers, and patient groups are insisting that weight loss will improve health and therefore offset these massive costs. Known as GLP-1 agonists, the drugs — Wegovy and Ozempic from Novo Nordisk and Eli Lilly's Mounjaro — mimic a gut hormone known as glucagon-like peptide 1, helping to suppress people's appetites and slow their digestion. Brent Eberle, the chief pharmacy officer at Navitus, said very few of the employers that worked with his pharmacy-benefit manager paid for weight-loss drugs.
Persons: that's, They're, AJ Loiacono, Li Ran, James Gelfand, Eli Lilly's, Ozempic, drugmakers, Brent Eberle, Navitus, Eberle, it's, Pat Gleason, Gleason, Wegovy, Eli Lilly, Lilly, Florian Gaertner, Loiacono Organizations: Morning, Novo Nordisk, Getty, Workers, Drugmakers, Therapeutics, Blue, Mayo Clinic, and Drug Administration, Capital Locations: Novo, Xinhua
Loneliness, social isolation linked with early death
  + stars: | 2023-06-19 | by ( Kristen Rogers | ) edition.cnn.com   time to read: +7 min
The new paper, however, is a meta-analysis of 90 studies that had examined the links between loneliness, social isolation and early death among more than 2 million adults. People who experienced social isolation had a 32% higher risk of dying early from any cause compared with those who weren’t socially isolated. Holt-Lunstad was the lead scientist on the US Surgeon General’s recent advisory report on social isolation and loneliness. Broadening social connectionsPeople experiencing social isolation and loneliness should actively seek social support, Wang said. Public health strategies to address loneliness and social isolation, including raising awareness, are also needed, Wang said.
Persons: Turhan Canli, Canli wasn’t, Julianne Holt, wasn’t, Holt, Lunstad, Anthony Ong, Ong wasn’t, ” Holt, Canli, , ” Canli, Fan Wang, , Ong, Wang Organizations: CNN, Stony Brook University, Brigham Young University in, Center, Integrative Developmental, Human Health Labs, Cornell University, , Harbin Medical University Locations: Brigham Young University in Utah, New York, China
How to Exercise When It’s Humid
  + stars: | 2023-06-17 | by ( Danielle Friedman | ) www.nytimes.com   time to read: +1 min
Anyone who has gone for a jog on a hot, muggy day knows how miserable it can be — not only because your shirt is glued to your back, experts say, but also because humidity makes exercise much more challenging. This is because the sweat on your skin doesn’t easily evaporate, said JohnEric Smith, an associate professor of exercise physiology at Mississippi State University. Sweat itself doesn’t cool you, he said, but rather the evaporation of sweat. When the air is already thick with water vapor, however, “there’s nowhere for the moisture on our skin to go,” he said. As a result, humid air makes it harder for your body to cool down.
Persons: JohnEric Smith, , Organizations: Mississippi State University
A 2022 study found night owls were more sedentary, had lower aerobic fitness levels, and burned less fat at rest and while active than early birds. Night owls were also more likely to be insulin-resistant, meaning their muscles required more insulin to be able to get the energy they need, the study showed. Studies have revealed night owls may take more risks and are more likely to skip breakfast and eat more later in the day. Night owls also have higher levels of visceral body fat in the abdominal region, a key risk factor for type 2 diabetes and heart disease. “The strongest reset for the circadian system is bright light,” Zee said.
Persons: , Christer Hublin, Bhanu Prakash Kolla, ” Kolla, Phyllis Zee, Zee, ” Zee Organizations: CNN —, Finnish Institute of Occupational Health, Center for Sleep Medicine, Mayo Clinic, Center, Northwestern University Feinberg School of Medicine, CNN, Northwestern Locations: Helsinki, Rochester , Minnesota, Chicago
The bivalent shots offered last fall included protection against the Omicron variant and an early Covid variant. is expected to make a more official recommendation to vaccine makers soon. The manufacturers will be expected to study the new formulas and submit data to the agency. spokesman said it expected that an updated vaccine would be available by late September, assuming the data support safe and effective vaccines. It remains unclear whether or when the vaccine makers or the F.D.A.
Persons: , Peter Marks, Natalie Thornburg Organizations: Pfizer, Moderna, Centers for Disease Control, World Health Organization, Agency Locations: United States
Food addiction: What it is and how to overcome it
  + stars: | 2023-06-15 | by ( Kristen Rogers | ) edition.cnn.com   time to read: +11 min
Known as food addiction, the condition isn’t limited to older adults — previous food addiction data had primarily centered around young- to middle-age adults up to around 50, said Ashley Gearhardt, lead author of the latest research by Michigan Medicine and a pioneer in the field of food addiction studies. But the type of treatment that would be offered for food addiction would be very different, because not everyone who reports having food addiction is binging, and the underlying neurology of food addiction and binge eating disorder aren’t the same. Food hijacking the brainThe criteria defining food addiction revolve specifically around highly processed food, instead of all food, because of how the brain responds to its consumption, experts said. Living with food addictionNot everyone who eats highly processed food develops an addictive relationship to it. “So, I don’t have science to say, ‘Here is the best treatment for this addiction,’ which is unfortunate.”Undergoing therapy can help with food addiction.
Persons: Ashley Gearhardt, Gearhardt, Kristin Kirkpatrick, wasn’t, , ’ ”, hasn’t, she’s, they’re, ” Kirkpatrick, “ It’s, ” Avena, It’s, , Nicole Avena, Kirkpatrick, we’ve, ” Gearhardt, they’ll, , it’s, — you’re, we’re Organizations: CNN, Michigan Medicine, Cleveland Clinic, University of Michigan, Disorders Locations: New York, Michigan
More than 75 million people in the eastern US were under air quality alerts as wildfire smoke shrouded major cities. People with chronic lung and heart conditions should continue to monitor air quality, CNN Medical Analyst Dr. Leana Wen said. CNN: What are the short-term health effects of wildfire smoke inhalation? And there is research that has linked wildfire smoke exposure events to an increase in influenza months later, suggesting that there could be lagging effects. CNN: If people were exposed for a few days to bad air quality, should they be worried about long-term consequences?
Persons: Leana Wen, Wen, we’ve, Mandel Ngan Organizations: CNN, UN, Program, George Washington University Milken Institute School of Public Health, Getty Locations: Canada, York, Washington, AFP
Eli Lilly also is expected to present data on another weight-loss drug called orforglipron, which patients take orally instead of through an injection. Retatrutide, Mounjaro and weight-loss drug Wegovy, produced by rival Novo Nordisk (NVO), are all injectable. But if the data were to fall short of expectations, the analysts don't foresee much downside to J & J shares. However, with JNJ-2113, Morgan Stanley noted that J & J management has touted its efficacy profile "without the baggage of a JAK label." J & J has consistently denied those accusations.
Persons: Eli Lilly, Johnson, Morgan Stanley —, Eli Lilly Eli Lilly, Morgan Stanley, Eli Lilly's Mounjaro, Mounjaro, Lilly's, retatrutide, hasn't, haven't, Jim Cramer's, Jim Cramer, Jim, AJ Mast Organizations: American Diabetes Association, Novo Nordisk, U.S . Food, Drug Administration, Pfizer, Novo Nordisk's, Johnson, American Academy of Dermatology, topline, J's, LTL Management, CNBC, Bloomberg, Getty, & ' $ Locations: U.S, Novo, Indianapolis , Indiana
CNN —Like many adults, a lot of teenagers don’t know what they want to do when they grow up. Even when they think they do, they may not have a realistic grasp of whether a given occupation or job is likely to be economically viable for them over time. After assessing all those elements, the role is assigned a CFI score — the higher the number, the more economically viable a job is. The gap between popular occupations and viable onesThe Gallup-Amazon report identifies, among other things, how wide the gap is between a given career’s economic viability score and how popular its ranking is among 15-year-olds. For instance, among jobs that largely employ people without a bachelor’s degree, 27 careers score at or above the average score for positions typically filled by college graduates.
Persons: don’t, , , Jonathan Rockwell Organizations: CNN, Gallup, Amazon, CFI, ” Gallup
As a doctor and food scientist, I've spend 20 years studying how our diets can help us beat diseases and live longer. Both the Mediterranean region and Asia have areas known as Blue Zones, where people age better, live longer, and are overall healthier. Here are the five staples of MediterAsian eating that can help you boost immune health and live longer:1. Lentils: Lentils are a classic legume in Mediterranean cuisine. Bottles and jarsExtra virgin olive oil (EVOO): EVOO is the most desirable form of olive oil.
Persons: I've, Roe Locations: Asia
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